Immediate extubation post-surgery in cardiac patients: a retrospective single-center case series and literature review

BACKGROUND: Immediate extubation following cardiac surgery is rarely performed, largely due to concerns over hemodynamic instability, respiratory compromise, and potential postoperative complications. Most centers limit immediate extubation to low-risk patients, leaving its broader applicability less understood. This study utilized a standardized anesthetic procedure to implement immediate extubation in a diverse cardiac surgical population with varying risk profiles based on a single-center case series. METHODS: We retrospectively reviewed the medical records of 34 cardiac surgery patients (congenital, valve, aortic, and coronary artery bypass grafting) from May 2024 to January 2025. A standardized, 10-step perioperative procedure was employed to facilitate immediate extubation. The effects of immediate extubation were assessed by extubation time, intensive care unit (ICU) length of stay, hospital length of stay, and postoperative complications. RESULTS: This study included 34 patients (73.5% male, mean age 55.9 ± 16.1 years), predominantly New York Heart Association class II (55.9%) and American Society of Anesthesiologists class IV (52.9%). Most completed preoperative pulmonary training with nebulization, and 88.2% maintained negative fluid balance pre-surgery. Valve replacements comprised 67.6% of cases, followed by coronary artery bypass grafting (17.6%) and congenital cardiac defect repairs (11.8%). Immediate extubation was achieved in 97.1% of patients (33/34), with mean extubation time of 5 ± 4.7 min post-operation. Mean ICU stay was 4 ± 4.1 days and postoperative hospitalization 14 ± 5.9 days. Acute kidney injury represented the most common complication (33.3%), followed by delirium (18.2%) and 24-hour reintubation (9.1%). Most perioperative complications remained manageable within standard protocols. CONCLUSION: Immediate extubation appears feasible in a carefully selected cohort of predominantly minimally invasive cardiac surgery patients managed under a standardised perioperative protocol, with an immediate extubation success rate of 97.1%. Larger, prospective, risk-stratified studies are needed before immediate extubation can be recommended as a broadly safe strategy across all cardiac surgical subgroups.