Implementation and Results of On-Table Extubation Following Hypothermic Circulatory Arrest: Early Experience and Outcomes

The objective of this study is to discuss the implementation, safety, and potential benefits of on-table extubation (OTE) in surgeries involving hypothermic circulatory arrest (HCA). A retrospective analysis of all consecutive cases involving HCA from 2021 to 2024 was completed. The setting of this study is a single, tertiary academic medical center. All cardiac surgery patients undergoing HCA during the study period were evaluated for inclusion in this study. The intervention in this study was the implementation of OTE in patients undergoing HCA. Twelve out of 85 (14%) patients underwent OTE following HCA. In this cohort, there were no post-operative reintubations, major complications, or mortalities. The median intensive care unit (ICU) length of stay was 21.5 hours, and the median duration of hospitalization was 6.6 days. Patients undergoing fast track extubation (FTE) (extubation within 6 hours post-operatively), or extubation >6 hours had a median ICU length of stay of 42.1 hours (P = 0.12) and 91.8 hours (P < 0.01) and a hospital length of stay of 5.0 days (P = 0.03) and 11.5 days (P = 0.02), respectively. There were no reintubations or mortalities in the FTE group, and five reintubations and ten mortalities in the >6 hour group. OTE in patients undergoing HCA is feasible and demonstrated minimal post-operative complications in our cohort. Consideration of these cases for OTE may improve outcomes and appears to be safe in select patients. Centers experienced with OTE should consider internal evaluation of their readiness to broaden OTE to traditionally more “high-risk” populations on a case-by-case basis.