Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2016 Sep 12;9(9):CD003587.
doi: 10.1002/14651858.CD003587.pub3.

Fast-track cardiac care for adult cardiac surgical patients

Wai-Tat Wong  1 , Veronica Kw Lai, Yee Eot Chee, Anna Lee
Affiliations
Review

Fast-track cardiac care for adult cardiac surgical patients

Wai-Tat Wong et al. Cochrane Database Syst Rev. .

Abstract

Background: Fast-track cardiac care is a complex intervention involving several components of care during cardiac anaesthesia and in the postoperative period, with the ultimate aim of early extubation after surgery, to reduce length of stay in the intensive care unit and in the hospital. Safe and effective fast-track cardiac care may reduce hospital costs. This is an update of a Cochrane review first published in 2003, updated in 2012 and updated now in 2016.

Objectives: To determine the safety and effectiveness of fast-track cardiac care compared with conventional (not fast-track) care in adult patients undergoing cardiac surgery. Fast-track cardiac care intervention includes administration of low-dose opioid-based general anaesthesia or use of a time-directed extubation protocol, or both.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 5), MEDLINE (January 2012 to May 2015), Embase (January 2012 to May 2015), the Cumulative Index to Nursing and Allied Health Literature (CINAHL; January 2012 to May 2015) and the Institute for Scientific Information (ISI) Web of Science (January 2012 to May 2015), along with reference lists of articles, to identify additional trials. We applied no language restrictions.

Selection criteria: We included all randomized controlled trials of adult cardiac surgical patients (coronary artery bypass grafts, aortic valve replacement, mitral valve replacement) that compared fast-track cardiac care and conventional (not fast-track) care groups. We focused on the following fast-track interventions, which were designed for early extubation after surgery: administration of low-dose opioid-based general anaesthesia during cardiac surgery and use of a time-directed extubation protocol after surgery. The primary outcome was risk of mortality. Secondary outcomes included postoperative complications, reintubation within 24 hours of surgery, time to extubation, length of stay in the intensive care unit and in the hospital, quality of life after surgery and hospital costs.

Data collection and analysis: Two review authors independently assessed trial quality and extracted study data. We contacted study authors for additional information. We calculated a Peto odds ratio (OR) for risk of mortality and used a random-effects model to report risk ratio (RR), mean difference (MD) and 95% confidence intervals (95% CIs) for all secondary outcomes.

Main results: We included 28 trials (4438 participants) in the updated review. We considered most participants to be at low to moderate risk of death after surgery. We assessed two studies as having low risk of bias and 11 studies high risk of bias. Investigators reported no differences in risk of mortality within the first year after surgery between low-dose versus high-dose opioid-based general anaesthesia groups (OR 0.53, 95% CI 0.25 to 1.12; eight trials, 1994 participants, low level of evidence) and between a time-directed extubation protocol versus usual care (OR 0.80, 95% CI 0.45 to 1.45; 10 trials, 1802 participants, low level of evidence).Researchers noted no significant differences between low-dose and high-dose opioid-based anaesthesia groups in the following postoperative complications: myocardial infarction (RR 0.98, 95% CI 0.48 to 1.99; eight trials, 1683 participants, low level of evidence), stroke (RR 1.17, 95% CI 0.36 to 3.78; five trials, 562 participants, low level of evidence) and tracheal reintubation (RR 1.77, 95% CI 0.38 to 8.27; five trials, 594 participants, low level of evidence).Comparisons with usual care revealed no significant differences in the risk of postoperative complications associated with a time-directed extubation protocol: myocardial infarction (RR 0.59, 95% CI 0.27 to 1.31; eight trials, 1378 participants, low level of evidence), stroke (RR 0.85, 95% CI 0.33 to 2.16; 11 trials, 1646 participants, low level of evidence) and tracheal reintubation (RR 1.34, 95% CI 0.74 to 2.41; 12 trials, 1261 participants, low level of evidence).Although levels of heterogeneity were high, low-dose opioid anaesthesia was associated with reduced time to extubation (reduction of 4.3 to 10.5 hours, 14 trials, 2486 participants, low level of evidence) and length of stay in the intensive care unit (reduction of 0.4 to 7.0 hours, 12 trials, 1394 participants, low level of evidence). Use of a time-directed extubation protocol was associated with reduced time to extubation (reduction of 3.7 to 8.8 hours, 16 trials, 2024 participants, low level of evidence) and length of stay in the intensive care unit (reduction of 3.9 to 10.5 hours, 13 trials, 1888 participants, low level of evidence). However, these two fast-track care interventions were not associated with reduced total length of stay in the hospital (low level of evidence).

Authors' conclusions: Low-dose opioid-based general anaesthesia and time-directed extubation protocols for fast-track interventions have risks of mortality and major postoperative complications similar to those of conventional (not fast-track) care, and therefore appear to be safe for use in patients considered to be at low to moderate risk. These fast-track interventions reduced time to extubation and shortened length of stay in the intensive care unit but did not reduce length of stay in the hospital.

PubMed Disclaimer

Conflict of interest statement

WTW, VKWL and YEC declare no potential conflict of interests in this review. AL co‐authored a previous related systematic review (Myles 2003), along with Professor Paul Myles; two of his trials are included in this updated review (Myles 1997; Myles 2002). As AL was also co‐author of a trial included in this updated review (Zhu 2015), WTW and VKWL independently performed data extraction.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 2 Time‐directed extubation protocols, outcome: 2.4 Subgroup analysis.
1.1
1.1. Analysis
Comparison 1 Dose of opioid‐based cardiac anaesthesia, Outcome 1 Mortality.
1.2
1.2. Analysis
Comparison 1 Dose of opioid‐based cardiac anaesthesia, Outcome 2 Postoperative complications.
1.3
1.3. Analysis
Comparison 1 Dose of opioid‐based cardiac anaesthesia, Outcome 3 Service outcomes.
2.1
2.1. Analysis
Comparison 2 Time‐directed extubation protocol, Outcome 1 Mortality.
2.2
2.2. Analysis
Comparison 2 Time‐directed extubation protocol, Outcome 2 Postoperative complications.
2.3
2.3. Analysis
Comparison 2 Time‐directed extubation protocol, Outcome 3 Service outcomes.
2.4
2.4. Analysis
Comparison 2 Time‐directed extubation protocol, Outcome 4 Subgroup analysis.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD003587.pub2

References

References to studies included in this review

Bell 1994 {published data only}
    1. Bell J, Sartain J, Wilkinson GAL, Sherry KM. Propofol and fentanyl anaesthesia for patients with low cardiac output state undergoing cardiac surgery: comparison with high‐dose fentanyl anaesthesia. British Journal of Anaesthesia 1994;73(2):162‐6. [PUBMED: 7917729] - PubMed
Berry 1998 {published data only}
    1. Berry PD, Thomas SD, Mahon SP, Jackson M, Fox MA, Fabri B, et al. Myocardial ischaemia after coronary artery bypass grafting: early vs late extubation. British Journal of Anaesthesia 1998;80(1):20‐5. [MEDLINE: ] - PubMed
Chang 2007 {published data only}
    1. Chang FL, Lin SL, Tsai CS, Yeh CC, Wu CT, Wong CS. Closed‐circuit isoflurane‐based anesthesia provides better fast‐tracking anesthesia than fentanyl/propofol‐based anesthesia for off‐pump coronary artery bypass graft surgery. Acta Anaesthesiologica Taiwanica 2007;45:135‐9. [PUBMED: 17972615] - PubMed
Cheng 1996a,1996b, 2003 {published data only}
    1. Cheng DC, Wall C, Djaiani G, Peragallo RA, Carroll J, Li C, et al. Randomized assessment of resource use in fast‐track cardiac surgery 1‐year after hospital discharge. Anesthesiology 2003;98(3):651‐7. [MEDLINE: ] - PubMed
    1. Cheng DCH, Karski J, Peniston C, Asokumar B, Raveendran G, Carroll J, et al. Morbidity outcome in early versus conventional tracheal extubation after coronary artery bypass grafting: a prospective randomized controlled trial. Journal of Thoracic and Cardiovascular Surgery 1996;112(3):755‐64. [MEDLINE: ] - PubMed
    1. Cheng DCH, Karski J, Peniston C, Raveendran G, Asokumar B, Carroll J, et al. Early tracheal extubation after coronary artery bypass graft surgery reduces costs and improves resource use. Anesthesiology 1996;85(6):1300‐10. [MEDLINE: ] - PubMed
Dumas 1999 {published data only}
    1. Dumas A, Dupuis GH, Searle N, Cartier R. Early versus late extubation after coronary artery bypass grafting: effects on cognitive function. Journal of Cardiothoracic and Vascular Anesthesia 1999;13(2):130‐5. [PUBMED: 10230943 ] - PubMed
Engoren 1998 {published data only}
    1. Engoren MC, Kraras C, Garzia F. Propofol‐based versus fentanyl‐isoflurane‐based anesthesia for cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia 1998;12(2):177‐81. [PUBMED: 9583550] - PubMed
Gruber 2008 {published data only}
    1. Gruber PC, Gomersall CD, Leung P, Joynt GM, Ng SK, Ho KM, et al. Randomized controlled trial comparing adaptive‐support ventilation with pressure‐regulated volume‐controlled ventilation with automode in weaning patients after cardiac surgery. Anesthesiology 2008;109(1):81‐7. [PUBMED: 18580176] - PubMed
Kadoi 2003 {published data only}
    1. Kadoi Y, Saito S, Kunimoto F, Goto F, Fujita N. Comparative effects of propofol versus fentanyl on cerebral oxygenation state during normothermic cardiopulmonary bypass and postoperative cognitive dysfunction. The Annals of Thoracic Surgery 2003;75(3):840‐6. [PUBMED: 12645704] - PubMed
Lu 2003 {published data only}
    1. Lu CC, Ho ST, Wang JJ, Wong CS, Tsai CS, Chang SY, et al. Minimal low‐flow isoflurane‐based anesthesia benefits patients undergoing coronary revascularization via preventing hyperglycemia and maintaining metabolic homeostasis. Acta Anaesthesiologica Sinica 2003;41:165‐72. [PUBMED: 14768513] - PubMed
Maddali 2006 {published data only}
    1. Maddali MM, Kurian E, Fahr J. Extubation time, hemodynamic stability, and postoperative pain control in patients undergoing coronary artery bypass surgery: an evaluation of fentanyl, remifentanil, and nonsteroidal antiinflammatory drugs with propofol for perioperative and postoperative management. Journal of Clinical Anesthesia 2006;18(8):605‐10. [PUBMED: 17175431] - PubMed
Michalopoulos 1998 {published data only}
    1. Michalopoulos A, Nikolaides C, Antzaka C, Deliyanni M, Smirli A, Geroulanos S, et al. Change in anaesthesia practice and postoperative sedation shortens ICU and hospital length of stay following coronary artery bypass surgery. Respiratory Medicine 1998;92(8):1066‐70. [PUBMED: 9893777] - PubMed
Myles 1997 {published data only}
    1. Myles PS, Buckland MR, Weeks AM, Bujor MA, McRae R, Langley M, et al. Hemodynamic effects, myocardial ischemia, and timing of tracheal extubation with propofol‐based anesthesia for cardiac surgery. Anesthesia and Analgesia 1997;84(1):12‐9. [PUBMED: 8988992] - PubMed
Myles 2002 {published and unpublished data}
    1. Myles PS, Hunt JO, Fletcher H, Watts J, Bain D, Silvers A, et al. Remifentanil, fentanyl, and cardiac surgery: a double‐blinded, randomized, controlled trial of costs and outcomes. Anesthesia and Analgesia 2002;95(4):805‐12. [PUBMED: 12351249] - PubMed
Nicholson 2002 {published data only}
    1. Nicholson DJ, Kowalski SE, Hamilton GA, Meyers MP, Serrette C, Duke PC. Postoperative pulmonary function in coronary artery bypass graft surgery patients undergoing early tracheal extubation: a comparison between short‐term mechanical ventilation and early extubation. Journal of Cardiothoracic and Vascular Anesthesia 2002;16(1):27‐31. [PUBMED: 11854874] - PubMed
Nougarede 2004 {published data only}
    1. Nougarede B, Caillet C, Bizouarn P, Maupeti JC, Blanloeil Y, Furic I. Impact of propofol and sufentanil target controlled infusion with monitoring of bispectral index on drugs and medical device costs in operating room and intensive care unit, for routine cardiac surgery with cardiopulmonary bypass. Journal de Pharmacie Clinique 2004;23:219‐26.
Pettersson 2004 {published data only}
    1. Pettersson PH, Settergren G, Owall A. Similar pain scores after early and late extubation in heart surgery with cardiopulmonary bypass. Journal of Cardiothoracic Vascular Anesthesia 2004;18(1):64‐7. [PUBMED: 14973802] - PubMed
Probst 2014 {published data only}
    1. Probst S, Cech C, Haentschel D, Scholz M, Ender J. A specialized post‐anaesthetic care unit improves fast‐track management in cardiac surgery: a prospective randomized trial. Critical Care 2014;18(4):468‐79. [PUBMED: 25123092] - PMC - PubMed
Quasha 1980 {published data only}
    1. Quasha AL, Loeber N, Feeley TW, Ullyot DJ, Roizen MF. Postoperative respiratory care: a controlled trial of early and late extubation following coronary artery bypass grafting. Anesthesiology 1980;52(2):135‐41. [PUBMED: 6986104] - PubMed
Reyes 1997 {published and unpublished data}
    1. Reyes A, Vega G, Blancas R, Morato B, Moreno J, Torrecilla C, et al. Early vs conventional extubation after cardiac surgery with cardiopulmonary bypass. Chest 1997;112(1):193‐201. [PUBMED: 9228376] - PubMed
Sakaida 1998 {published and unpublished data}
    1. Sakaida K. [Isoflurane anesthesia with combined use of low dose fentanyl for open heart surgery]. Masui 1998;47(5):576‐84. [PUBMED: 9621668] - PubMed
Salah 2015 {published data only}
    1. Salah M, Hosny H, Salah M, Saad H. Impact of immediate versus delayed tracheal extubation on length of ICU stay of cardiac surgical patients, a randomized trial. Heart, Lung and Vessels 2015;7(4):311‐9. [CTG: NCT02491749] - PMC - PubMed
Sherry 1996 {published data only}
    1. Sherry KM, McNamara J, Brown JS, Drummond M. An economic evaluation of propofol/fentanyl compared with midazolam/fentanyl on recovery in the ICU following cardiac surgery. Anaesthesia 1996;51(4):312‐7. [PUBMED: 8686815] - PubMed
Silbert 1998 {published data only}
    1. Silbert BS, Santamaria JD, O'Brien JL, Blyth CM, Kelly WJ, Molnar RR, et al. Early extubation following coronary artery bypass surgery: a prospective randomized controlled trial. Chest 1998;113:1481‐8. [PUBMED: 9631781] - PubMed
Silbert 2006 {published data only}
    1. Silbert BS, Scott DA, Evered LA, Lewis MS, Kalpokas M, Maruff P, et al. A comparison of the effect of high‐ and low‐dose fentanyl on the incidence of postoperative cognitive dysfunction after coronary artery bypass surgery in the elderly. Anesthesiology 2006;104(6):1137‐45. [PUBMED: 16732083] - PubMed
Simeone 2002 {published data only}
    1. Simeone F, Biagioli B, Scolletta S, Marullo AC, Marchet‐Ti L, Caciorgna M, et al. Optimization of mechanical ventilation support following cardiac surgery. Journal of Cardiovascular Surgery (Torino) 2002;43(5):633‐41. [PUBMED: 12386574] - PubMed
Slogoff 1989 {published data only}
    1. Slogoff S, Keats AS. Randomized trial of primary anesthetic agents on outcome of coronary artery bypass operations. Anesthesiology 1989;70(2):179‐88. [PUBMED: 2521549] - PubMed
van Mastrigt 2006a, 2010 {published data only}
    1. Mastrigt GA, Heijmans J, Severens JL, Fransen EJ, Roekaerts P, Voss G, et al. Short‐stay intensive care after coronary artery bypass surgery: randomized clinical trial on safety and cost‐effectiveness. Critical Care Medicine 2006;34(1):65‐75. [MEDLINE: ] - PubMed
    1. Mastrigt GA, Joore MA, Nieman FH, Severens JL, Maessen JG. Health‐related quality of life after fast‐track treatment results from a randomized controlled clinical equivalence trial. Quality of Life Research 2010;19(5):631‐42. [PUBMED: 20340049] - PMC - PubMed
Zhu 2015 {published and unpublished data}
    1. Zhu F, Gomersall CD, Ng SK, Underwood MJ, Lee A. A randomized controlled trial of adaptive support ventilation mode to wean patients after fast‐track cardiac valvular surgery. Anesthesiology 2015;122(4):832‐40. [PUBMED: 25569810] - PubMed

References to studies excluded from this review

Anastasiadis 2013 {published data only}
    1. Anastasiadis K, Asteriou C, Antonitsis P, Argiriadou H, Grosomanidis V, Kyparissa M, et al. Enhanced recovery after elective coronary revascularization surgery with minimal versus conventional extracorporeal circulation: a prospective randomized study. Journal of Cardiothoracic and Vascular Anesthesia 2013;27(5):859‐64. [PUBMED: 23791499] - PubMed
Anderson 2010 {published data only}
    1. Anderson J, Henry L, Hunt S, Ad N. Bispectral index monitoring to facilitate early extubation following cardiovascular surgery. Clinical Nurse Specialist 2010;24(3):140‐8. [PUBMED: 20404622] - PubMed
Cagli 2003 {published data only}
    1. Cagli K, Uncu H, Iscan Z, Altintas G, Karadeniz U, Vural K, et al. The efficiency of fast track protocol in elderly patients who underwent coronary artery surgery. Anadolu Kardiyologi Dergisi. 2003;3(1):8‐12, AXVII. [MEDLINE: ] - PubMed
Cheng 2001 {published data only}
    1. Cheng DC, Newman MF, Duke P, Wong DT, Finegan B, Howie M, et al. The efficacy and resource utilization of remifentanil and fentanyl in fast‐track coronary artery bypass graft surgery: a prospective randomized, double‐blinded controlled, multi‐center trial. Anesthesia and Analgesia 2001;92:1094‐102. [PUBMED: 11323328] - PubMed
Delphin 2007 {published data only}
    1. Delphin E, Jackson D, Gubenko Y, Botea A, Esrig B, Fritz W, et al. Sevoflurane provides earlier tracheal extubation and assessment of cognitive recovery than isoflurane in patients undergoing off‐pump coronary artery bypass surgery. Journal of Cardiothoracic and Vascular Anesthesia 2007;21(5):690‐5. [PUBMED: 17905275] - PubMed
El Tahan 2013 {published data only}
    1. Tahan MR, Khidr AM. Low target sufentanil effect‐site concentrations allow early extubation after valve surgery. Journal of Cardiothoracic and Vascular Anesthesia 2013;27(1):63‐70. [PUBMED: 22406043] - PubMed
Ender 2008 {published data only}
    1. Ender J, Borger MA, Scholz M, Funkat AK, Anwar N, Sommer M, et al. Cardiac surgery fast‐track treatment in a postanesthetic care unit: six‐month results of the Leipzig fast‐track concept. Anesthesiology 2008;109:61‐6. [MEDLINE: ] - PubMed
Engoren 2001 {published data only}
    1. Engoren M, Luther G, Fenn‐Buderer N. A comparison of fentanyl, sufentanil, and remifentanil for fast‐track cardiac anesthesia. Anesthesia and Analgesia 2001;93(4):859‐64. [PUBMED: 11574346] - PubMed
Farag 2006 {published data only}
    1. Farag E, Chelune GJ, Schubert A, Mascha EJ. Is depth of anesthesia, as assessed by the Bispectral Index, related to postoperative cognitive dysfunction and recovery?. Anesthesia and Analgesia 2006;103(3):633‐40. [PUBMED: 16931673] - PubMed
Forestier 2003 {published data only}
    1. Forestier F, Hirschi M, Rouget P, Rigal JC, Videcoq M, Girardet P, et al. Propofol and sufentanil titration with the bispectral index to provide anesthesia for coronary artery surgery. Anesthesiology 2003;99(2):334‐46. [PUBMED: 12883406] - PubMed
Gerlach 2002 {published data only}
    1. Gerlach K, Uhlig T, Hüppe M, Kraatz E, Saager L, Schmitz A, et al. Remifentanil‐clonidine‐propofol versus sufentanil‐propofol anesthesia for coronary artery bypass surgery. Journal of Cardiothoracic and Vascular Anesthesia 2002;16(6):703‐8. [PUBMED: 12486650] - PubMed
Gozdzik 2003 {published data only}
    1. Gozdzik W, Durek G, Maslanka P, Adamik B, Namieta K, Kubler A, et al. Perioperative endocrine stress response in patients undergoing CABG surgery under remifentanil propofol total intravenous anaesthesia. Anestezjologia Intensywna Terapia 2003;35:157‐64.
Hall 1991 {published data only}
    1. Hall RI, Murphy JT, Moffitt EA, Landymore R, Pollak PT, Poole L. A comparison of the myocardial metabolic and haemodynamic changes produced by propofol‐sufentanil and enflurane‐sufentanil anaesthesia for patients having coronary artery bypass graft surgery. Canadian Journal of Anesthesia 1991;38(8):996‐1004. [PUBMED: 1836422] - PubMed
Hansdottir 2006 {published data only}
    1. Hansdottir V, Philip J, Olsen MF, Eduard C, Houltz E, Ricksten SE. Thoracic epidural versus intravenous patient‐controlled analgesia after cardiac surgery: a randomized controlled trial on length of hospital stay and patient‐perceived quality of recovery. Anesthesiology 2006;104(1):142‐51. [PUBMED: 16394700] - PubMed
Heck 2000 {published data only}
    1. Heck M, Kumle B, Boldt J, Lang J, Lehmann A, Saggau W. Electroencephalogram bispectral index predicts hemodynamic and arousal reactions during induction of anesthesia in patients undergoing cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia 2001;14(6):693‐7. [PUBMED: 11139111] - PubMed
Heijmans 2007 {published data only}
    1. Heijmans J, Fransen E, Buurman W, Maessen J, Roekaerts P. Comparison of the modulatory effects of four different fast‐track anesthetic techniques on the inflammatory response to cardiac surgery with cardiopulmonary bypass. Journal of Cardiothoracic and Vascular Anesthesia 2007;21(4):512‐8. [PUBMED: 17678776] - PubMed
Howie 2003 {published data only}
    1. Howie MB, Michelsen LG, Hug CC Jr, Porembka DT, Jopling MW, Warren SM. Comparison of three remifentanil dose‐finding regimens for coronary artery surgery. Journal of Cardiothoracic and Vascular Anesthesia 2003;17(1):51‐9. [PUBMED: 12635061] - PubMed
Jacobsohn 2005 {published data only}
    1. Jacobsohn E, Lee TW, Amadeo RJ, Syslak PH, Debrouwere RG, Bell D, et al. Low‐dose intrathecal morphine does not delay early extubation after cardiac surgery. Canadian Journal of Anesthesia 2005;52(8):848‐57. [PUBMED: 16189338] - PubMed
Kataoka 2007 {published data only}
    1. Kataoka G, Murai N, Kodera K, Sasaki A, Asano R, Ikeda M, et al. Clinical experience with Smart Care after off‐pump coronary artery bypass for early extubation. Journal of Artificial Organs 2007;10(4):218‐22. [PUBMED: 18071851] - PubMed
Knapik 2006 {published data only}
    1. Knapik M, Knapik P, Nadziakiewicz P, Misiołek H, Saucha W, Walaszczyk M, et al. Comparison of remifentanil or fentanyl administration during isoflurane anesthesia for coronary artery bypass surgery. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research 2006;12(8):133‐8. [PUBMED: 16865075] - PubMed
Koslov 1995 {published data only}
    1. Kozlov IA, Markin SM, Piliaeva IE, Alferov AV. [Early cessation of artificial ventilation of the lungs (extubation of the trachea in the operating room) in patients undergoing surgery with artificial circulation]. Anesteziologiia i Reanimatologiia 1995;March‐April(2):16‐9. [MEDLINE: ] - PubMed
Lehmann 2003 {published data only}
    1. Lehmann A, Karzau J, Boldt J, Thaler E, Lang J, Isgro F. Bispectral index‐guided anesthesia in patients undergoing aortocoronary bypass grafting. Anesthesia and Analgesia 2003;96(2):336‐43. [PUBMED: 12538174] - PubMed
Lena 2005 {published data only}
    1. Lena P, Balarac N, Arnulf JJ, Bigeon JY, Tapia M, Bonnet F. Fast‐track coronary artery bypass grafting surgery under general anesthesia with remifentanil and spinal analgesia with morphine and clonidine. Journal of Cardiothoracic and Vascular Anesthesia 2005;19(1):49‐53. [PUBMED: 15747269] - PubMed
Lena 2008 {published data only}
    1. Lena P, Balarac N, Lena D, Chapelle A, Arnulf JJ, Mihoubi A, et al. Fast‐track anesthesia with remifentanil and spinal analgesia for cardiac surgery: the effect on pain control and quality of recovery. Journal of Cardiothoracic Vascular Anesthesia 2008;22(4):536‐42. [MEDLINE: ] - PubMed
Lison 2007 {published data only}
    1. Lison S, Schill M, Conzen P. Fast‐track cardiac anesthesia: efficacy and safety of remifentanil versus sufentanil. Journal of Cardiothoracic and Vascular Anesthesia 2007;21(1):35‐40. [PUBMED: 17289477] - PubMed
McDonald 2005 {published data only}
    1. McDonald SB, Jacobsohn E, Kopacz DJ, Desphande S, Helman JD, Salinas F, et al. Parasternal block and local anesthetic infiltration with levobupivacaine after cardiac surgery with desflurane: the effect on postoperative pain, pulmonary function, and tracheal extubation times. Anesthesia and Analgesia 2005;100(1):25‐32. [PUBMED: 15616047] - PubMed
Mollhoff 2001 {published data only}
    1. Möllhoff T, Herregods L, Moerman A, Blake D, MacAdams C, Demeyere R, et al. Comparative efficacy and safety of remifentanil and fentanyl in 'fast track' coronary artery bypass graft surgery: a randomized, double‐blind study. British Journal of Anaesthesia 2001;87(5):718‐26. [PUBMED: 11878522] - PubMed
Murphy 2009 {published data only}
    1. Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS, et al. Morphine‐based cardiac anesthesia provides superior early recovery compared with fentanyl in elective cardiac surgery patients. Anesthesia and Analgesia 2009;109(2):311‐9. [PUBMED: 19608797] - PubMed
Najafi 2008 {published data only}
    1. Najafi M. Fast‐track method in cardiac surgery: evaluation of risks and benefits of continuous administration technique. Singapore Medical Journal 2008;49(6):470‐5. [MEDLINE: ] - PubMed
Oliver 2011 {published data only}
    1. Oliver WC Jr, Nuttall GA, Murari T, Bauer LK, Johnsrud KH, Hall Long KJ, et al. A prospective, randomized, double‐blind trial of 3 regimens for sedation and analgesia after cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia 2011;25:110‐9. [PUBMED: 20850348] - PubMed
Puri 2003 {published data only}
    1. Puri GD, Murthy SS. Bispectral index monitoring in patients undergoing cardiac surgery under cardiopulmonary bypass. European Journal of Anaesthesiology 2003;20(6):451‐6. [PUBMED: 12803261] - PubMed
Ramsay 1994 {published data only}
    1. Ramsay JG, DeLima LG, Wynands JE, O'Connor JP, Ralley FE, Robbins GR. Pure opioid versus opioid‐volatile anesthesia for coronary artery bypass graft surgery: a prospective, randomized, double‐blind study. Anesthesia and Analgesia 1994;78(5):867‐75. [PUBMED: 8160983] - PubMed
Rose 2014 {published data only}
    1. Rose L, Schultz MJ, Cardwell CR, Jouvet P, McAuley DF, Blackwood B. Automated versus non‐automated weaning for reducing the duration of mechanical ventilation for critically ill adults and children. Cochrane Database of Systematic Reviews 2014, Issue 6. [DOI: 10.1002/14651858.CD009235.pub3; PUBMED: 24915581] - DOI - PMC - PubMed
Royse 2003 {published data only}
    1. Royse C, Royse A, Soeding P, Blake D, Pang J. Prospective randomised trial of high thoracic epidural analgesia for coronary artery bypass surgery. The Annals of Thoracic Surgery 2003;75(1):93‐100. [PUBMED: 12537199] - PubMed
Shroff 1997 {published data only}
    1. Shroff A, Rooke GA, Bishop MJ. Effects of intrathecal opioid on extubation time, analgesia, and intensive care unit stay following coronary artery bypass grafting. Journal of Clinical Anesthesia 1997;9(5):415‐9. [PUBMED: 9257210] - PubMed
Sulzer 2001 {published data only}
    1. Sulzer CF, Chioléro R, Chassot PG, Mueller XM, Revelly JP. Adaptive support ventilation for fast tracheal extubation after cardiac surgery: a randomized controlled study. Anesthesiology 2001;95(6):1339‐45. [PUBMED: 11748389] - PubMed
Tempe 1995 {published data only}
    1. Tempe D, Cooper A, Mohan JC, Nigam M, Tomar AS, Ramesh K, et al. Closed mitral valvotomy and elective ventilation in the postoperative period: effect of mild hypercarbia on right ventricular function. Journal of Cardiothoracic and Vascular Anesthesia 1995;9(5):552‐7. [PUBMED: 8547558] - PubMed
Tempe 2011 {published data only}
    1. Tempe DK, Dutta D, Garg M, Minhas H, Tomar A, Virmani S. Myocardial protection with isoflurane during off‐pump coronary artery bypass grafting: a randomized trial. Journal of Cardiothoracic and Vascular Anesthesia 2011;25(1):59‐65. [PUBMED: 20580572] - PubMed
Yorulmaz 2005 {published data only}
    1. Yorulmaz V, Arar C, Turan N, Pamukcu Z. Comparison of effects of sevoflurane and high‐dose fentanyl anesthesia on hemodynamic profile and postoperative recovery in coronary artery surgery. Turk Anesteziyoloji ve Reanimasyon Dernegi Dergisi 2005;33(1):63‐8.
Zeydanoglu 2005 {published data only}
    1. Zeydanoglu S, Bilir A, Ekemen S, Tanriverdi B. Comparison of remifentanil and fentanyl on early extubation and recovery at coronary artery bypass grafting. Anesteziyoloji ve Reanimasyon Uzmanları Derneği 2005;13(4):237‐42.

Additional references

Alhan 2003
    1. Alhan C, Toruman F, Karabulut EH, Tarcan S, Dagdelens S, Eren N, et al. Fast track recovery of high risk coronary bypass surgery patients. European Journal of Cardiothoracic Surgery 2003;23(5):678‐83. [MEDLINE: ] - PubMed
American Heart Association 2016
    1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Executive Summary: Heart Disease and Stroke Statistics‐2016 Update: A Report From the American Heart Association. Circulation 2016;133(4):447‐54. [PUBMED: 26811276] - PubMed
Badhwar 2014
    1. Badhwar V, Esper S, Brooks M, Mulukutla S, Hardison R, Mallios D, et al. Extubating in the operating room after adult cardiac surgery safely improves outcomes and lowers costs. Journal of Thoracic and Cardiovascular Surgery 2014;148(6):3101‐9. [PUBMED: 25173117] - PubMed
Blackwood 2014
    1. Blackwood B, Burns KE, Cardwell CR, O'Halloran P. Protocolized versus non‐protocolized weaning for reducing the duration of mechanical ventilation in critically ill adult patients. Cochrane Database of Systematic Reviews 2014, Issue 11. [DOI: 10.1002/14651858.CD006904.pub3; PUBMED: 25375085] - DOI - PMC - PubMed
Chamchad 2010
    1. Chamchad D, Horrow JC, Nachamchik L, Sutter FP, Samuels LE, Trace CL, et al. The impact of immediate extubation in the operating room after cardiac surgery on intensive care and hospital length of stay. Journal of Cardiothoracic and Vascular Anesthesia 2010;24:780‐4. [PUBMED: 20650657] - PubMed
Constantinides 2006
    1. Constantinides VA, Tekkis PP, Fazil A, Kaur K, Leonard R, Platt M, et al. Fast‐track failure after cardiac surgery: development of a prediction model. Critical Care Medicine 2006;34(12):2875‐82. [PUBMED: 17075376] - PubMed
Deeks 2010
    1. Deeks JJ, Higgins JPT. Statistical algorithms in Review Manager 5. http://www.cochrane.org/sites/default/files/uploads/handbook/Statistical... (accessed 16 March 2016).
Egger 1997
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. BMJ 1997;315(7109):629‐34. [PUBMED: 9310563] - PMC - PubMed
Elmagarmid 2014
    1. Elmagarmid A, Fedorowicz Z, Hammady H, Ilyas I, Khabsa M, Ouzzani M. Rayyan: a systematic reviews web app for exploring and filtering searches for eligible studies for Cochrane Reviews. Evidence‐Informed Public Health: Opportunities and Challenges. Abstracts of the 22nd Cochrane Colloquium. Hyderabad, India: John Wiley & Sons, 2014.
Faul 2014 [Computer program]
    1. Faul F. G*Power 3.1.9.2. Universitat Kiel, Germany, 2014.
Greco 2012
    1. Greco M, Landoni G, Biondi‐Zoccai G, Cabrini L, Ruggeri L, Pasculli N, et al. Remifentanil in cardiac surgery: a meta‐analysis of randomized controlled trials. Journal of Cardiothoracic and Vascular Anesthesia 2012; Vol. 26, issue 1:110‐6. [PUBMED: 21820920] - PubMed
Guyatt 2011
    1. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction‐GRADE evidence profiles and summary of findings tables. Journal of Clinical Epidemiology 2011;64(4):383‐94. [PUBMED: 21195583] - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60. [PUBMED: 12958120] - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. www.cochrane‐handbook.org.
Ho 2011
    1. Ho KM, Tan JA. Benefits and risks of maintaining normothermia during cardiopulmonary bypass in adult cardiac surgery: a systematic review. Cardiovascular Therapeutics 2011;29:260‐79. [PUBMED: 20041882] - PubMed
Kiessling 2013
    1. Kiessling AH, Huneke P, Reyher C, Bingold T, Zierer A, Moritz A. Risk factor analysis for fast track protocol failure. Journal of Cardiothoracic Surgery 2013;Mar 15(8):47. [PUBMED: 23497403 ] - PMC - PubMed
Landoni 2011
    1. Landoni G, Augoustides JG, Guarracino F, Santini F, Ponschab M, Pasero D, et al. Mortality reduction in cardiac anesthesia and intensive care: results of the first International Consensus Conference. Acta Anaesthesiologica Scandinavica 2011;55(3):259‐66. [PUBMED: 21288207] - PubMed
Lee 2013
    1. Lee A, Zhu F, Underwood MJ, Gomersall CD. Fast‐track failure after cardiac surgery: external model validation and implications to ICU bed utilization. Critical Care Medicine 2013;41(5):1205‐13. [PUBMED: 23388511 ] - PubMed
Meades 2001
    1. Meade MO, Guyatt G, Butler R, Elms B, Hand L, Ingram A, et al. Trials comparing early vs late extubation following cardiovascular surgery. Chest 2001;120(6 Suppl):445S‐53S. [PUBMED: 11742964] - PubMed
Michel 2003
    1. Michel P, Roques F, Nashef SA, EuroSCORE Project Group. Logistic or additive EuroSCORE for high‐risk patients?. European Journal of Cardiothoracic Surgery 2003;23(5):684‐7. [PUBMED: 12754018] - PubMed
Peters 2008
    1. Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L. Contour‐enhanced meta‐analysis funnel plots help distinguish publication bias from other causes of asymmetry. Journal of Clinical Epidemiology 2008;61(10):991‐6. [PUBMED: 18538991] - PubMed
Silbert 2009
    1. Silbert BS, Myles PS. Is fast‐track cardiac anesthesia now the global standard of care?. Anesthesia and Analgesia 2009;108(3):689‐91. [PUBMED: 19224767] - PubMed
Svircevic 2009
    1. Svircevic V, Nierich AP, Moons KGM, Bruinsma GJBB, Kalkman CJ, Dijk D. Fast‐track anesthesia and cardiac surgery: a retrospective cohort study of 7989 patients. Anesthesia and Anagesia 2009;108(3):727‐33. [PUBMED: 19224776] - PubMed
Svircevic 2013
    1. Svircevic V, Passier MM, Nierich AP, Dijk D, Kalkman CJ, Heijden GJ. Epidural analgesia for cardiac surgery. Cochrane Database of Systematic Reviews 2013, Issue 6. [DOI: 10.1002/14651858.CD006715.pub2; PUBMED: 23740694] - DOI - PubMed
van Mastrigt 2006b
    1. Mastrigt GA, Maessen JG, Heijmans J, Severens JL, Prins MH. Does fast‐track treatment lead to a decrease of intensive care unit and hospital length of stay in coronary artery bypass patients? A meta‐regression of randomized clinical trials. Critical Care Medicine 2006;34(6):1624‐34. [PUBMED: 16614584] - PubMed

References to other published versions of this review

Hawkes 2003
    1. Hawkes CA, Dhileepan S, Foxcroft D. Early extubation for adult surgical patients. Cochrane Database of Systematic Reviews 2003, Issue 4. [DOI: 10.1002/14651858.CD003587] - DOI - PubMed
Myles 2003
    1. Myles PS, Daly DJ, Djaiani G, Lee A, Cheng DCH. A systematic review of the safety and effectiveness of fast‐track cardiac anesthesia. Anesthesiology 2003;99(4):982‐7. [PUBMED: 14508335] - PubMed
Zhu 2012
    1. Zhu F, Lee A, Chee YE. Fast‐track cardiac care for adult cardiac surgical patients. Cochrane Database of Systematic Reviews 2012, Issue 10. [DOI: 10.1002/14651858.CD003587.pub2; PUBMED: 23076899] - DOI - PubMed

LinkOut - more resources