Myocardial ischaemia after coronary artery bypass grafting: early vs late extubation

Abstract

The technique of early extubation after coronary artery bypass grafting is increasing in popularity, but its safety and effect on myocardial ischaemia remain to be established. In a randomized, prospective study, patients undergoing routine elective coronary artery bypass grafting were managed with either early or late tracheal extubation. The incidence and severity of electrocardiographic myocardial ischaemia were compared. Data were analysed from 85 patients (43 early extubation; 42 late extubation). Median time to extubation was 110 min in the early extubation patients and 757 min in the late extubation patients. After correction for randomization bias, there were no significant differences between groups in ischaemic burden, maximal ST-segment deviation, incidence of ischaemia and area under the ST deviation-time curve (integral of ST deviation and time). Similarly, there were no differences between groups in postoperative creatine kinase MB-isoenzyme concentrations and duration of stay in the ICU or hospital. Therefore, this study provides evidence for the safety of early extubation after routine coronary artery bypass grafting.

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

“…690 Continuous telemetric monitoring of cardiac rate and rhythm is recommended for 48 to 72 hours after surgery in all patients because of the high incidence of post-CABG AF, which most often occurs 2 and 4 days after surgery. 606,613,690,691,697,698 In addition, other arrhythmias and conduction abnormalities may occur in patients with ischemia because of incomplete revascularization or in those undergoing concurrent valve replacement.…”

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

“…61 Ischemia monitoring can also be helpful in the early postoperative period, [216][217][218][219] with potential to guide targeted therapeutic efforts, including surgical revision or early angiography and percutaneous revasculariza tion, 220,221 and was given a COR IIb, LOE B recommen dation in published guidelines. …”

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

“…Electrocardiographic monitoring includes an assessment of heart rate and rhythm as well as the morphology and deviation of the QRS complex and ST segments for evidence of ischemia, infarction, or abnormal conduction (690). Continuous telemetric monitoring of cardiac rate and rhythm is recommended for 48 to 72 hours after surgery in all patients because of the high incidence of post-CABG AF, which most often occurs 2 and 4 days after surgery (606,613,690,691,697,698). In addition, other arrhythmias and conduction abnormalities may occur in patients with ischemia because of incomplete revascularization or in those undergoing concurrent valve replacement.…”