Improving On Fast-track Protocol for Post Cardiac Surgery Patients

Tham, Yi Chuan; Tam, Anna; Sharad, Shah S; Chia, Stanley; Ong, K. K.

doi:10.1186/1749-8090-10-s1-a330

Cited by 2 publications

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“…Conversely, a 2013 retrospective analysis of over 11,000 patients found age and left ventricular dysfunction were significant preoperative predictors of failure FTCA [ 20 ]. Most recently, a 2018 prospective observational study concluded that age, pre-existing renal impairment, Euroscore, inotropic requirement, aortic cross-clamp time and total cardiopulmonary bypass time were all predictors of FTCA failure [ 21 ]. To summarize, the available evidence suggests that, predictably, FTCA is more likely to be successful in younger patients with fewer comorbidities and greater baseline cardiac function, with ongoing work required to determine hard criteria for FTCA patient selection.…”

Section: Main Textmentioning

confidence: 99%

Fast-track recovery program after cardiac surgery in a teaching hospital: a quality improvement initiative

et al. 2021

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Objective Fast-track cardiac anesthesia (FTCA) is a technique that may improve patient access to surgery and maximize workforce utilization. However, feasibility and factors impacting FTCA implementation remain poorly explored both locally and internationally. We describe the specific intraoperative and postoperative protocols for our FTCA program, assess protocol compliance and identify reasons for FTCA failure. Results We tested the program in 16 patients undergoing elective cardiac surgery requiring cardiopulmonary bypass. There was 100% compliance with the FTCA protocols. Four (25%) patients successfully completed the FTCA protocol (extubated < 4 h postoperatively and discharged from the intensive care unit on the same operative day).

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Section: Main Textmentioning

confidence: 99%

Fast-track recovery program after cardiac surgery in a teaching hospital: a quality improvement initiative

et al. 2021

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“…[3,16] The fi rst enhanced recovery programs in cardiovascular surgical procedures were the so-called fast-track and ultra-fast track programs, introduced in the 1990s. [17][18][19] These proposed shortening the duration of orotracheal extubation and postoperative ventilation mechanics, which are risk factors for respiratory complications, as well as shortened stays in hospitals and intensive care units (ICUs). But these actions were focused on a single stage of the perioperative period and were not multidisciplinary.…”

Section: Introductionmentioning

confidence: 99%

“…In cardiac surgery, such fasttrack and ultra fast-track programs are not applied to all cardiac surgical procedures or to all patients. [17,[19][20][21][22][23][24][25][26] Between 2017 and 2019, publications on the results of ERAS programs in cardiac surgery increased. [6,14,19,23,[27][28][29][30][31][32][33] World leaders in the specialty recognized the need to adapt the original ERAS programs to cardiac surgery patient characteristics and to each type of intervention, and to generalize a protocol based on the best scientifi c evidence.…”

Section: Introductionmentioning

confidence: 99%

“…[17,[19][20][21][22][23][24][25][26] Between 2017 and 2019, publications on the results of ERAS programs in cardiac surgery increased. [6,14,19,23,[27][28][29][30][31][32][33] World leaders in the specialty recognized the need to adapt the original ERAS programs to cardiac surgery patient characteristics and to each type of intervention, and to generalize a protocol based on the best scientifi c evidence. [2,14,34,35] The fi rst cardiosurgical symposium for development, evaluation and control of enhanced recovery protocols was held in 2017, whereas ERAS experts published the fi rst ERAS guidelines for cardiac surgery in March 2019,[34,36,37] collectively known as 'ERACS protocols or guidelines'.…”

Section: Introductionmentioning

confidence: 99%

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Improved Recovery Protocols in Cardiac Surgery: A Systematic Review and Meta-Analysis of Observational and Quasi-Experimental Studies

2021

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INTRODUCTION Improved recovery protocols were implemented in surgical specialties over the last decade, which decreased anesthetic and surgical stress and the incidence of perioperative complications. However, these recovery protocols were introduced more slowly for cardiac surgeries. The most frequent complications in cardiac surgery are related to patient clinical status and the characteristics of the surgical procedures involved, which are becoming more varied and complex every day. The fi rst version of the enhanced recovery program for cardiac surgery was published in 2019, but its recommendations were based on only a few studies, and scant research has evaluated its implementation. Randomized and controlled clinical trials for these protocols are scarce, so research that summarizes the results of studies with other methodological designs are useful in demonstrating their benefi ts in cardiovascular surgery services in Cuba and in other limited-resource settings.OBJECTIVE Estimate the effectiveness of improved recovery protocols in the perioperative evolution of patients undergoing cardiac surgery. METHODSWe performed a systematic review and metaanalysis according to the guidelines of manual 5.1.0 for reviews of the Cochrane library. We included observational and quasiexperimental studies published from January 2015 through May 2020 that compared enhanced recovery protocols with conventional treatments in patients older than 18 years, and used a quality score to evaluate them. We used the following sources: the Cochrane Library, PubMed, LILACS, SciELO, EBSCO, Google Scholar, Web of Science, Clinical Key, ResearchGate and HINARI. The following keywords were used for the database searches in English: ERAS, protocols and cardiac surgery, enhanced recovery after cardiac surgery, ERACS, clinical pathway recovery and cardiac surgery, perioperative care and cardiac surgery. We used the following search terms for databases in Spanish: protocolos de recuperación precoz and cirugía cardiaca, protocolos de recuperación mejorada and cirugía cardiaca, cuidados perioperatorios and cirugía cardiaca, programas de recuperación precoz and cirugía cardiovascular. Methodological quality of included investigations was evaluated using the surgical research methodology scale. Meta-analyses were performed for perioperative complications, intensive care unit and hospital stays, and hospital readmission within 30 days of surgery. We calculated effect sizes of the interventions and the corresponding 95% confi dence intervals. We used mean differences and confi dence intervals for continuous variables, and for qualitative variables we calculated relative risk (RR). Random effects analysis was used. Heterogeneity of the studies was assessed using the Q statistic and the I 2 statistic. RESULTSWe selected 15 studies (a total of 5059 patients: study group, n = 1706; control group, n = 3353). The average quality score for the 15 articles included was 18.9 (out of a maximum of 36 according to the scale) and 66.6% had a score ≥18. With improv...

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Improving On Fast-track Protocol for Post Cardiac Surgery Patients

Cited by 2 publications

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Fast-track recovery program after cardiac surgery in a teaching hospital: a quality improvement initiative

Fast-track recovery program after cardiac surgery in a teaching hospital: a quality improvement initiative

Improved Recovery Protocols in Cardiac Surgery: A Systematic Review and Meta-Analysis of Observational and Quasi-Experimental Studies

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