Early extubation protocol post-coronary artery bypass graft & open heart surgery

Fast-tracking in cardiac care refers to the complex intervention including early extubation, care during anesthesia, mobilization and hospital discharge to reduce perioperative morbidity, costs, and length of stay in the intensive care unit and the hospital. This review was designed to evaluate early extubation protocols, the differences in early and late extubation, the safety and efficacy of early extubation among the patients in surgical intensive care after coronary artery bypass graft (CABG) surgery. The analyzed studies showed many significant differences in the mortality and postoperative complications of time-directed extubation practices and low dose-based general anesthesia in patients with low to moderate risk undergoing early extubation (fast-track) and the conventional care methods. Different fast-track interventions could diminish extubation time, costs, and the length of hospital stay. However, several factors including patient’s stay in the intensive therapy ward vs general ward, patient selection, skills and experience of the staff, and fast-track anesthesia methods could be considered to perform safe fast-tracking in patients undergoing cardiac surgery. On the other hand, to achieve this safety for high-risk cardiosurgery patients multidisciplinary coordination is needed.