ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Intensive Care Cardiovascular Medicine
This article is part of the Research TopicInnovative Monitoring and Management of Perioperative Complications in Cardiac SurgeryView all 11 articles
Ultra-fast extubation following cardiac surgery improves hemodynamic stability and reduces ICU workload
Provisionally accepted
Vito Angiuli1
Marc Rohner1
Maria Wittmann1
Florian Piekarski1
Jacqueline Kruse1Miriam Silaschi1Andrea Kunsorg1Andreas Mayr2Izdar Abulizi2Jan Speller3
Farhad Bakhtiary1
Markus Velten4*- 1Universitatsklinikum Bonn, Bonn, Germany
- 2Philipps-Universitat Marburg, Marburg, Germany
- 3Universitat Munster, Münster, Germany
- 4University of Texas Southwestern Medical Center, Dallas, United States
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Objective: To address ICU capacity constraints, particularly during the COVID-19 pan-demic, we implemented an ultra-fast extubation (UFE) protocol involving extubation in the operating room (ORE) following on-pump cardiac surgery. We hypothesize that ORE is safe, improves postoperative outcomes, and reduces ICU workload compared to standard extubation in the ICU (ICUE). Methods: We retrospectively analyzed 397 adult patients who underwent on-pump cardiac surgery at a tertiary center between February and October 2021. Following propensity score matching (n=224), patients were stratified into ORE and ICUE groups. Primary outcomes included hemodynamic stability assessed via the Simplified Acute Physiology Score (SAPS) and ICU workload measured by the Therapeutic Intervention Scoring System (TISS). Secondary outcomes included duration of mechanical ventilation, vasopressor requirements, ICU and hospital length of stay (LOS), and transfusion needs. Results: Patients extubated in the OR demonstrated significantly lower SAPS and TISS scores on admission and cumulatively during ICU treatment (p<0.001), reflecting improved hemodynamic stability and reduced ICU workload. ORE patients also had lower postoperative vasoactive-inotropic scores, and reduced cate-cholamine use (all p<0.001). ICU LOS was significantly shorter in the ORE group (median 24.5 vs. 45.0 hours, p=0.023), while hospital LOS was comparable. Conclusion: Ultra-fast extubation after cardiac surgery appears to be a safe and effective strategy to reduce ICU workload and resource use without compromising patient outcomes. ORE may be a valuable component of enhanced recovery protocols in cardiac surgical care.
Keywords: Enhanced Recovery After Cardiac Surgery, ultra fast extubation, extubation in the OR, ICU workload, cardiac anesthesia
Received: 30 Aug 2025; Accepted: 27 Oct 2025.
Copyright: © 2025 Angiuli, Rohner, Wittmann, Piekarski, Kruse, Silaschi, Kunsorg, Mayr, Abulizi, Speller, Bakhtiary and Velten. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Markus Velten, markus.velten@utsouthwestern.edu
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