Early Versus Late Extubation in Pediatric Cardiac Surgery: A Systematic Review

Abstract

Background

Early extubation (EE) and immediate extubation (IE) after pediatric cardiac surgery are increasingly being studied with the aim of lowering hospital and intensive care unit (ICU) stays, and postoperative complications. The aim of this systematic review was to assess the outcomes of EE and IE versus traditional delayed extubation (DE) in children undergoing surgery for congenital heart disease.

Methods

This study was conducted in line with the PRISMA guidelines. Articles comparing outcomes of EE versus DE in pediatric patients undergoing cardiac surgery between 2014 and 2023 were identified using PubMed, Web of Science, and CENTRAL. The Newcastle–Ottawa scale was employed to assess the quality of the included studies.

Results

A total of 22 studies including 8359 patients were included. Two IE studies and 6 EE studies reported significantly higher reintubation rates as compared with DE, indicating variability across populations and practices. The ICU length of stay was notably shorter for the IE group in 7 studies and for the EE group in 7 studies as compared with DE; 1 IE study reported a longer ICU stay. Six studies in the IE group and 5 in the EE group showed significantly shorter hospital stays as compared with DE. Lastly, 2 studies in the EE group showed higher mortality than in the DE group.

Conclusion

In a selective population, EE proved advantageous with quicker recovery and less use of resources. However, to optimize patient selection and outcomes, standardization of the procedures and additional prospective research are needed.

Keywords

congenital heart disease congenital heart surgery intensive care mortality outcomes (includes mortality morbidity)pediatric surgery complications postoperative care

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