Abstract:

Objective To analyse the perioperative data of patients undergoing surgery with cardiopulmonary bypass (CPB) under fast-track cardiac anesthesia (FTCA), establish the cutoff value of early extubation in FTCA standards, and explore the CPB related factors associated with FTCA. Methods The data of 2 859 children undergoing surgery for congenital heart disease managed with FTCA strategy were retrospectively analysed. Cluster analysis was performed with logarithmic transformation of the time of mechanical ventilation after surgery to establish pediatric FTCA standards of cutoff value of early extubation after operation. The related factors of FTCA were analysed by chi-square test and stepwise multiple Cox regression analysis. Results Cluster analysis of time of mechanical ventilation after operation revealed that 12 h after operation was the cutoff value for early extubation after operation. There were 54.56% of patients with time of extubation ＜12 h after operation (early extubation group), and there were 45.44% of patients with time of extubation ≥12 h after operation (non-early extubation group). The early extubation rates after operation were 83.1%, 66.3%, 42.5%, 28.7% and 26.8% in different time of CPB (≤30 min, 31-60 min, 61-90 min, 91-120 min and >120 min） groups respectively, and there were significant differences among groups (P<0.01). The early extubation rates after operation were 55.6%, 71.8%, 46.4%, 27.6% and 20.9% in different time of aortic cross-clamping （0 min, 1-30 min, 31-60 min, 61-90 min and >90 min）groups, and there were significant differences among groups (P<0.01). The early extubation rates after operation were 66.9%, 49.6%, 29.0% and 21.5% in different temperatures of CPB (room temperature, mild hypothermia, moderate hypothermia and profound hypothermia) groups, and there were significant differences among groups (P<0.01). Stepwise multiple Cox regression analysis indicated that longer time of CPB resulted in lower rate of early extubation after operation. The rate of early extubation after operation in time of aortic cross-clamping of 1-30 min group was higher than that in control group (0 min)(P<0.05), there was no significant difference in the rates of early extubation after operation between time of aortic cross-clamping of 31-60 min and 61-90 min groups and control group (P>0.05), and the rates of early extubation after operation in time of aortic cross-clamping >90 min group was lower than that in control group. Lower temperature of CPB resulted in lower rate of early extubation after operation. Conclusion Twelve hours after operation was defined as the cutoff value of early extubation in FTCA standard. Time of CPB, time of aortic crossclamping and temperature of CPB are CPB related factors for extubation after operation.

Key words: fast-track, cardiopulmonary bypass, congenital heart disease, surgery, related factors, children