Enhanced Recovery after Surgery (ERAS) in Pediatric Cardiac Surgery: Status Quo of Implementation in Europe

Abstract

Objectives: Enhanced recovery after surgery (ERAS) is a multimodal care pathway to enhance recovery after surgery that is well established in various surgical disciplines. In pediatric cardiac surgery, implementation of ERAS protocols remains inconsistent. We conducted a survey of active European pediatric cardiac surgical centers to assess the current state of ERAS concepts and the current practice in perioperative pediatric cardiac care.

Design: Prospective, 79-item, web-based cross-sectional survey.

Setting: Web-based survey endorsed by the European Association of Cardiothoracic Anesthesiology and Intensive Care.

Participants: Anesthesiologists of European pediatric cardiac surgical centers.

Interventions: None.

Measurements and main results: Of a total of 98 centers, 50 responded. Eight responses were excluded due to incomplete survey forms or non-European location, leaving 42 responses (42.9%) for statistical analysis. Sixteen of the 42 centers (38.1%) follow an ERAS concept. Only 3 (7.1%) have formalized and detailed the ERAS concept in a written document, covering the entire perioperative period, while 13 (31%) have formalized it solely for the intraoperative period. Regarding regional and local anesthesia, 13 (31%) centers regularly practice regional anesthesia blocks, and 11 (26.2%) centers use wound infiltration by the surgical team.

Conclusion: This European survey revealed that implementation of ERAS concepts in pediatric cardiac surgery is generally low, with considerable heterogeneity in clinical practice regarding the timing of extubation, the choice of surgical procedures triggering on-table extubation, the choice of anesthetic drugs and the use of regional anesthesia. More coordinated efforts are needed to implement ERAS concepts in pediatric cardiac surgery and harvest the benefits of ERAS concepts for the pediatric cardiac population.

Keywords: ERAPCS; ERAS; enhanced recovery after surgery; fast track; on-table extubation; pediatric cardiac surgery.