Multicenter International Survey on the Clinical Practice of Ultra-Fast-Track Anesthesia with On-Table Extubation in Pediatric Congenital Cardiac Surgery

Abstract

Objective: To describe global practices for on-table extubation (OTE) in pediatric cardiac anesthesia in European and non-European countries.

Design: Multiple-choice, web-based survey with 34 questions addressing organizational data, existence of OTE programs, inclusion and exclusion criteria for OTE, and intraoperative and immediate postoperative management.

Setting: Online survey endorsed by the European Association of Cardiothoracic Anesthesiologists.

Participants: Anesthesiologists departments in European and non-European pediatric cardiac surgical centers.

Interventions: None.

Measurements and main results: The survey was sent to 144 pediatric cardiac surgical centers in 29 countries as a web-based questionnaire. Addressees were pediatric cardiac anesthesiologists who were members of European Association of Cardiothoracic Anesthesiologists or were known to the authors. The response rate was 63%. Fifty percent of the respondents were practicing in university hospitals. The survey demonstrated that 76% of the respondents practiced OTE, with 50% of the pediatric cardiac anesthesiologists regularly performing OTE in different proportions, ranging from 1 to 51% of on-pump pediatric cardiac surgeries. Seventy-seven percent of respondents made their decision to perform OTE on an individual case-by-case basis. Seventy-eight percent of the congenital cardiac lesions deemed eligible for OTE fell into Risk Adjustment for Congenital Heart Surgery-1 categories 1 and 2. In patients for whom OTE was planned, anesthesia primarily was maintained using a combined inhalational and intravenous technique. The main reasons not to perform OTE were that it was deemed to provide no major advantage (45%), to be dangerous (9%), or to decrease operating room efficiency by increasing operating room turnover time (36%).

Conclusion: The survey demonstrated that the majority of the approached pediatric cardiac anesthesiologists practice OTE regularly in pediatric cardiac surgery. Frequency of OTE and inclusion criteria vary widely. The observations made in this survey should prompt appropriately powered, randomized controlled clinical trials to examine the effect of OTE on various effectiveness and safety outcomes.

Keywords: on-table extubation; pediatric cardiac surgery; survey; ultra-fast-track anesthesia.