Back to the Future – Fast Track or Not?

Introduction:
“Fast-track” cardiac anaesthesia (FTCA) emerged in the 1990s and has since become a popular approach after heart surgery. FTCA a management protocol involving early extubation, early mobilisation, decreasing duration of ICU admission and hospital stay.

Objective:
To review the results with a FTCA Protocol for all patients requiring cardiac surgery at our institution.

Patients And Methodology:
Retrospective, single institution, single surgeon review of experience with 835 consecutive patients who presented for surgery in the Namibian Heart Centre from 2009 – 2015. Diagnosis, time to extubation, length of ICU and hospital admission, complications and mortality were investigated.

Results:
Of 835 patients, 473 were male and 362 were female. Average age was 49.73 (+/- 16.95 years) with a range of 1 year to 84 years. Operations performed were coronary artery bypass graft ( n = 285 ); coronary plus valve replacement ( n = 39 ); valve replacement or repair ( n = 357 ); congenital heart disease ( n = 136 ) and aortic aneurysm (n = 18) The FTCA Protocol could be applied in 647 of the 835 cases (77.48 %). Patients were extubated on average 3.41 hours (+/- 1.32 hours ) following ICU admission and the average ICU stay was 46.93 hours ( +/- 9.34 hours). ICU discharge criteria were haemodynamic stability, ability to initiate walking within ICU, laboratory investigations within normal limits. Mean duration of hospitalization was 6.56 days. 16 patients (1.8 %) who were extubated within the first 6 hours required re-intubation. 4 patients (0.45 %) developed peri operative lung infection.
30 day mortality was 4.9% ( n = 39 ).

Conclusions:
FTCA may be applied in a wide range of cardiac surgical interventions, without undue risk. Incidence of re-intubation, return to intensive care unit and peri-operative pneumonia are low with this approach.