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Early and Safe Extubation

Content Type: Protocols | Provider

Created: June 28, 2021
Contributor: ERAS Cardiac Collaborative Network
Editor: Alexander Gregory, MD, FRCPC

Summary

Early extubation after cardiac surgery has been associated with several potential benefits, including improved patient comfort, reduced ventilator-associated complications, shorter intensive care unit stays, and decreased healthcare costs. When incorporated thoughtfully, early extubation may support enhanced recovery pathways. However, successful implementation requires careful patient selection, multidisciplinary coordination, and close postoperative monitoring to ensure safety and effectiveness for each individual patient.

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AI Assistance Statement

This summary was developed with assistance from artificial intelligence and reviewed, edited, and approved by the listed editor(s). Reference: OpenAI (2025). ChatGPT (November version) [Large language model]. 
https://chat.openai.com

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The Virtual Education Center (VEC) and all included content are intended to inform ERAS Cardiac Members on a wide range of topics related to enhanced recovery. The information presented has been provided by enhanced recovery experts and is for educational purposes only.

It is not intended to describe, recommend, or suggest any specific medical practice or intervention, nor should it be considered formal medical advice or consultation. The ERAS Cardiac Society cannot guarantee that the information provided is accurate or complete in every respect. Therefore, the Society is not responsible for any errors, omissions, or clinical outcomes resulting from application of the information obtained through the VEC.

All healthcare professionals should continue to exercise sound clinical judgment and base therapeutic decisions on the best available evidence and patient specific factors.

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Educational Materials

Early Extubation: Benefits and Strategies

This recorded session from the ERAS Cardiac Virtual Meeting (2021) features members of the international ERAS Cardiac network discussing practical considerations and strategies for facilitating early extubation following cardiac surgery.

References

  1. Wong WT, Lai VK, Chee YE, et al. Fast-track cardiac care for adult cardiac surgical patients. Cochrane Database Syst Rev 2016;9(9):CD003587.
  2. Flynn BC, He J, Richey M, Wirtz K, Daon E. Early extubation without Increased Adverse Events in High-Risk Cardiac Surgical Patients. Ann Thorac Surg. 2019 Feb;107(2):453-459.
  3. Brovman EY, Tolis G, Hirji S, Axtell A, Fields K, Muehlschlegel JD, Urman RD, Deseda GAC, Kaneko T, Karamnov S. Association Between Early Extubation and Postoperative Reintubation After Elective Cardiac Surgery: A Biinstitutional Study. J Cardiothorac Vasc Anesth. 2021 Nov 27:S1053-0770(21)01031-4.
  4. Gershengorn HB, Wunsch H, Hua M, Bavaria JE, Gutsche J. Association of Overnight Extubation With Outcomes After Cardiac Surgery in the Intensive Care Unit. Ann Thorac Surg. 2019 Aug;108(2):432-442.
  5. Probst S, Cech C, Haentschel D, et al. A specialized post anaesthetic care unit improves fast-track management in cardiac surgery: a prospective randomized trial. Crit Care 2014;18(4):468.
  6. Ellis MF, Pena H, Cadavero A, Farrell D, Kettle M, Kaatz AR, Thomas T, Granger B, Ghadimi K. Reducing Intubation Time in Adult Cardiothoracic Surgery Patients With a Fast-track Extubation Protocol. Crit Care Nurse. 2021 Jun 1;41(3):14-24.
  7. Serena G, Corredor C, Fletcher N, et al. Implementation of a nurse-led protocol for early extubation after cardiac surgery: a pilot study. World J Crit Care Med 2019;8(3):28–35
  8. Chan JL, Miller JG, Murphy M, Greenberg A, Iraola M, Horvath KA.A Multidisciplinary Protocol-Driven Approach to Improve Extubation Times After Cardiac Surgery. Ann Thorac Surg. 2018 Jun;105(6):1684-1690.
  9. Grant MC, Isada T, Ruzankin P, Whitman G, Lawton JS, Dodd-O J, Barodka V; Johns Hopkins Enhanced Recovery Program for the Cardiac Surgery Working Group. Results from an enhanced recovery program for cardiac surgery. J Thorac Cardiovasc Surg. 2020 Apr;159(4):1393-1402.e7.
  10. Horswell JL, Herbert MA, Prince SL, et. al.: Routine immediate extubation after off-pump coronary artery bypass surgery: 514 consecutive patients. J Cardiothorac Vasc Anesth 2005; 19: pp. 282-287
  11. Dorsa AG, Rossi AI, Thierer J, et. al.: Immediate extubation after off-pump coronary artery bypass graft surgery in 1,196 consecutive patients: Feasibility, safety and predictors of when not to attempt it. J Cardiothorac Vasc Anesth 2011; 25: pp. 431-436.
  12. Chamchad D, Horrow JC, Nachamchik L, et. al.: The impact of immediate extubation in the operating room after cardiac surgery on intensive care and hospital lengths of stay. J Cardiothorac Vasc Anesth 2010; 24: pp. 780-784.
  13. Gangopadhyay S, Acharjee A, Nayak SK, et. al.: Immediate extubation versus standard postoperative ventilation: Our experience in on pump open heart surgery. Indian J Anaesth 2010; 54: pp. 525-530.
  14. Sostaric M, Gersak B, Novak-Jankovic V.: Early extubation and fast-track anesthetic technique for endoscopic cardiac surgery. Heart Surg Forum 2010; 13: pp. E190-E194.
  15. Badhwar V, Esper S, Brooks M, Mulukutla S, Hardison R, Mallios D, Chu D, Wei L, Subramaniam K. Extubating in the operating room after adult cardiac surgery safely improves outcomes and lowers costs. J Thorac Cardiovasc Surg. 2014 Dec;148(6):3101-9.e1.
  16. Subramaniam K, DeAndrade DS, Mandell DR, Althouse AD, Manmohan R, Esper SA, Varga JM, Badhwar V. Predictors of operating room extubation in adult cardiac surgery. J Thorac Cardiovasc Surg. 2017 Nov;154(5):1656-1665.e2.