Early extubation after pediatric cardiac surgery: systematic review, meta-analysis, and evidence-based recommendations

Abstract

Objective: To derive evidence-based recommendations regarding early extubation strategy after congenital cardiac surgery.

Outcomes: Incidence of total mortality, morbidity, reintubation, length, and costs of intensive care unit and hospital stay.

Evidence: Medline, Embase, and the Cochrane-controlled trial register on the Cochrane library were searched from the earliest achievable date of each database to present. No language restrictions were applied. Retrieved reprints were evaluated according to a priori inclusion criteria, and those included were critically appraised using established internal validity criteria. BENEFITS AND HARMS: Early extubation (in the operating room or ≤6 hours after surgery) was associated with a lower early mortality. There was a trend toward lower ICU and hospital length of stays, lower hospital costs, and less respiratory morbidity. There was no difference in the rate of reintubation in those extubated early versus late.

Conclusion: Early extubation appears safe and is associated with reduction in length of ICU and hospital stay without adverse effects on mortality or morbidity. However, studies to date are poor, heterogeneous, and not suitable to determine a causal effect. Therefore, there is need for a well-designed randomized clinical trial to demonstrate the potential significant benefits of early extubation.