Implementation of an Ultra-Fast Track Enhanced Recovery After Surgery (ERAS) Protocol in Coronary Artery Bypass Surgery: Early Results from a Pilot Study

Background: While ultra-fast track enhanced recovery after surgery (UFT ERAS) has been successfully applied in minimally invasive surgery, patients undergoing coronary artery bypass grafting (CABG) represent a challenge due to the invasive nature of the procedure, particularly the use of full sternotomy. Our objective was to adapt the UFT ERAS protocol for CABG patients to minimize the time spent on mechanical ventilation, reduce intensive care unit (ICU) and hospital length of stay (LOS), and improve overall postoperative recovery.

Methods: The UFT ERAS protocol focuses on three key areas: (1) Preoperative: thorough assessment, detailed education on the protocol. (2) Intraoperative: stringent fluid management, on-table extubation, multimodal anesthetic approach (short-acting narcotics, minimal opioid use, regional anesthetic procedures). (3) Postoperative: transfer to ward on postoperative day 1, early removal of drains and catheters, early and intensive physiotherapy (first mobilization 3 hours after extubation), pain control. This protocol was applied to 12 patients who met the following inclusion criteria: elective CABG, body mass index (BMI) < 35 kg/m², absence of severe comorbidities, especially pulmonary/neurological, and left ventricular ejection fraction (LVEF) >40%. Key outcomes were successful on-table extubation, ICU and hospital LOS, and UFT ERAS associated complications (reintubation, bleeding, readmission to ICU). Secondary outcomes were major adverse cardiac and cerebrovascular events (MACCE).

Results: Data are displayed as absolute numbers or median with interquartile range. All patients were male and 62 years (57.8–65.3) old. LVEF was 55% (55–60) and EuroScore II 0.64% (0.55–0.81). Cardiopulmonary bypass and cross-clamp time were 81.5 min (59.3–122.8) and 52 min (39.8–68.8). Total arterial revascularization was performed in 7 patients (58.3%), and number of distal anastomoses was 3 (3–4). On-table extubation was achieved in all 12 patients (100%). Reintubation was necessary in 1 patient (8.3%). There were no instances of bleeding or readmission to ICU. Time to chest tube removal was 21.7 hours (17.4–6.3) after surgery and early mobilization was achieved in 11 patients (91.7%). MACCE occurred in 1 patient (8.3%; stroke). ICU and hospital LOS were 1.05 days (0.8–1.9) and 7 days (6–7.25).

Conclusion: The implementation of an UFT ERAS protocol in CABG patients has shown promising early results, with successful on-table extubation and short ICU and hospital LOS. ERAS-associated complications were rare. These findings suggest that the UFT ERAS protocol is a safe and effective approach to optimizing recovery after CABG.

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Artikel online veröffentlicht:
11. Februar 2025