Frequency of Fast Track Extubation and Factors Affecting its Success in Adult Cardiac Surgery Patients: A Retrospective Analysis

Objective: The primary objective is to identify how often do adult patients, who undergo elective open-heart surgeries are fast track extubated. Secondary objectives are to identify the causes of delayed extubation and to quantify the frequency of re-intubation and hospital stay in fast-track patients. Study design: Retrospective cross-sectional study. Place and duration of the study: The Cardiovascular Intensive Care Unit (CICU) at Department of Anesthesia, Aga Khan University Hospital, Karachi, Pakistan, where data was collected from January 2021 to December 2022. Methodology: Data of 419 adult patients admitted to the CICU and who underwent elective open-heart surgery, during the study period were included. Demographic and clinical information of the patients was collected using proforma eliciting details keeping anonymity and confidentiality of patients. Statistical analysis was conducted by RStudio (version 4.1.2, Boston, USA). Results: There were 58.4% (n = 245) of 419 patients extubated within the FastTrack window. No significant differences were seen in demographic and clinical characteristics (except surgery type, P < 0.001). There was significant difference in intraoperative outcomes (CICU arrival time, temperature, Vasoactive-Inotropic Score [VIS], and hospital stay) between groups (P < 0.001). High inotropic support, late night cases, bleeding and hypothermia were the major causes of delayed extubation. Conclusion: In patients undergoing elective open heart surgeries including elective CABG, fast track extubation is a feasible, safe, and effective option in improving resource utilization and patient outcome. Early extubation and prevention of postoperative complication can be facilitated by optimizing perioperative care protocols. Fast-track protocols should be standardized to protect patient safety. Fast track extubation requires careful patient selection and individual patient characteristics need to be considered.