On-table Extubation after Open Heart Surgery in Children: An Experience from a Tertiary Care Hospital in a Developing Country

Background: Recent advances in various disciplines of medicine have significantly changed the courses following cardiac surgery in children. On-table extubation (OTE) after open heart surgery in children is evolving. Objective: To assess the rate of postoperative complications in children extubated on table after open heart surgery. Design: This is a retrospective, descriptive study. Setting: Operating room (OR) then admitted to the pediatric intensive care unit (PICU). Patients: All pediatric patients (between 0 and 18 years) undergoing open heart surgery between January 2011 and June 2013. Intervention: On-table extubation. Outcome Measures: Rates of immediate postoperative complications, i.e., re-intubation, significant bleeding, low cardiac output syndrome, and arrhythmia in PICU, were assessed. Data are presented as frequencies and mean±standard deviation. Results: A total of 82 patients were included. Mean age at time of operation was 7.25±6.6 years. Fifty-three percent (n=44) were <5 years old and 64% (n=53) were men. Ventricular septal defect (47%, n=39) was the most common lesion, followed by atrial septal defect (36%, n=30), and tetralogy of Fallot (15%, n=12), which were repaired. Cardiopulmonary bypass and aortic cross clamp time were 72.3±34.2 and 47.3±27.8 minutes, respectively. The mean inotrope score was 2.66±3.53. There was no mortality in the cohort, whereas 97.8% (n=80) had no complications during PICU stay. One patient (1.1%) required re-intubation for respiratory failure and one patient (1.1%) had arrhythmia that was medically managed. The mean length of PICU stay was 1.77±0.985 days. Conclusion: On-table extubation in children after open heart surgery was feasible and safe in selected group of patients. There was no major complication observed in the PICU.