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Perioperative factors of fast track extubation success following coronary artery bypass graft surgery: a literature review

  • Siddiq Wiratama ,
  • Yan Efrata Sembiring ,
  • Philia Setiawan ,


Introduction: Various studies have shown that fast-track cardiac care which its final aim is for early extubation after surgery, reduces hospital length of stays, cost, and post-operative morbidity rate. The main purpose of this study is to evaluate some perioperative factors as an independent predictor for a successful outcome for fast-track extubation (FTE) in patients undergoing coronary artery bypass graft surgery (CABG).

Method: This study analyzed multiple references using the keyword “Fast track Extubation”, “Perioperative Factors”, and “CABG”. Search engines such as PubMed, Google Scholar, ProQuest, and ClinicalKey were used to search for relevant papers from the last 15 years. We obtained total of 6 articles that meet our review criteria. We excluded some articles for not meeting our review methods considerations and by the year of publication that does not meet our standard.


Result: A total of 6 studies were identified regarding fast tract extubation post-CABG procedure. Numerous risk factor has been identified for successful of fast tract intubation after intubation such as post-operative bleeding, aortic cross-clamp time, cardio-pulmonary bypass time, chronic obstructive pulmonary disease, atrial fibrillation, ejection fraction pre-operative, diabetes mellitus, renal function, and patient age.

Conclusions: This study confirms that better perioperative profile such as age, good ejection fraction >40% has better chance for FTE success in patients undergoing CABG surgery.


  1. Akhtar MI, Sharif H, Hamid M, Samad K, Khan FH. Fast Track Extubation In Adult Patients On Pump Open Heart Surgery At A Tertiary Care Hospital. J Ayub Med Coll Abbottabad. 2016 Oct-Dec;28(4):639-643.
  2. Wong WT, Lai VKW, Chee YE, Lee A. Fast-track cardiac care for adult cardiac surgical patients. Cochrane Database of Systematic Reviews. 2016;9:Art. No.: CD003587. DOI: 10.1002/14651858.CD003587.pub3
  3. Toraman F, Evrenkaya S, Yuce M, Göksel O, Karabulut H, Alhan C. Fast-track recovery in noncoronary cardiac surgery patients. Heart Surg Forum. 2005;8(1):E61-4. doi: 10.1532/HSF98.20041138.
  4. Dallan LAO, F Lisboa LA, Dallan LRP, Jatene FB. Impact of COVID-19 on coronary artery surgery: Hard lessons learned. J Card Surg. 2021;36(9):3294-3295. doi: 10.1111/jocs.15769.
  5. Ott RA, Gutfinger DE, Alimadadian H, Selvan A, Miller M, Tanner T, Hlapcich WL, Gazzaniga AB. Conventional coronary artery bypass grafting: why women take longer to recover. J Cardiovasc Surg (Torino). 2001;42(3):311-5.
  6. Silbert BS, Myles PS. Is fast-track cardiac anesthesia now the global standard of care?. Anesth Analg. 2009;108(3):689-91. doi: 10.1213/ane.0b013e318193c439.
  7. Lima CA, Ritchrmoc MK, Leite WS, Silva DARG, Lima WA, Campos SL, Andrade AD. Impact of fast-track management on adult cardiac surgery: clinical and hospital outcomes. Rev Bras Ter Intensiva. 2019;31(3):361-367. doi: 10.5935/0103-507X.20190059.
  8. Gu WJ, Wu ZJ, Wang PF, Aung LH, Yin RX. Intravenous magnesium prevents atrial fibrillation after coronary artery bypass grafting: a meta-analysis of 7 double-blind, placebo-controlled, randomized clinical trials. Trials. 2012;13:41. doi: 10.1186/1745-6215-13-41.
  9. Sebekos K, Guiab K, Stamelos G, Evans T, Siddiqi M, Brigode W, Capron G, Kaminsky M, Bokhari F. Effect of Age Alone on Outcome of Acute Surgical Conditions Among Healthy Patients (Non-smokers, Non-obese, and No Comorbid Conditions). Am Surg. 2023;89(6):2368-2375. doi: 10.1177/00031348221091966.
  10. Lemaire A, Soto C, Salgueiro L, Ikegami H, Russo MJ, Lee LY. The impact of age on outcomes of coronary artery bypass grafting. J Cardiothorac Surg. 2020;15(1):158-63. doi: 10.1186/s13019-020-01201-3.
  11. Sharma G, Goodwin J. Effect of aging on respiratory system physiology and immunology. Clin Interv Aging. 2006;1(3):253-60. doi: 10.2147/ciia.2006.1.3.253.
  12. Vemuri SV, Rolfsen ML, Sykes AV, Takiar PG, Leonard AJ, Malhotra A, Spragg RG, Macedo E, Hepokoski ML. Association Between Acute Kidney Injury During Invasive Mechanical Ventilation and ICU Outcomes and Respiratory System Mechanics. Crit Care Explor. 2022;4(7):e0720. doi: 10.1097/CCE.0000000000000720.
  13. Lannemyr L, Bragadottir G, Krumbholz V, Redfors B, Sellgren J, Ricksten SE. Effects of Cardiopulmonary Bypass on Renal Perfusion, Filtration, and Oxygenation in Patients Undergoing Cardiac Surgery. Anesthesiology. 2017;126(2):205-213. doi: 10.1097/ALN.0000000000001461.
  14. Lazar HL. Glycemic Control during Coronary Artery Bypass Graft Surgery. ISRN Cardiol. 2012;2012:292490. doi: 10.5402/2012/292490.
  15. Kolahian S, Leiss V, Nürnberg B. Diabetic lung disease: fact or fiction? Rev Endocr Metab Disord. 2019;20(3):303-319. doi: 10.1007/s11154-019-09516-w.
  16. Herlitz J, Wognsen GB, Emanuelsson H, Haglid M, Karlson BW, Karlsson T, Albertsson P, Westberg S. Mortality and morbidity in diabetic and nondiabetic patients during a 2-year period after coronary artery bypass grafting. Diabetes Care. 1996;19(7):698-703. doi: 10.2337/diacare.19.7.698
  17. Santoz JMG. & Ruiz MC. Coronary Artery Surgery in Diabetic Patients. Rev Esp Cardiol. 2002;55(12):1311-22.
  18. Bucerius J, Gummert JF, Walther T, Doll N, Falk V, Onnasch JF, Barten MJ, Mohr FW. Impact of diabetes mellitus on cardiac surgery outcome. Thorac Cardiovasc Surg. 2003;51(1):11-6. doi: 10.1055/s-2003-37280.
  19. Cross TJ, Sabapathy S, Beck KC, Morris NR, Johnson BD. The resistive and elastic work of breathing during exercise in patients with chronic heart failure. Eur Respir J. 2012;39(6):1449-57. doi: 10.1183/09031936.00125011.
  20. Liang F, Wang Y. Coronary heart disease and atrial fibrillation: a vicious cycle. Am J Physiol Heart Circ Physiol. 2021;320(1):H1-H12.
  21. Lopes LA, Agrawal DK. Post-Operative Atrial Fibrillation: Current Treatments and Etiologies for a Persistent Surgical Complication. J Surg Res (Houst). 2022;5(1):159-172. doi: 10.26502/jsr.10020209.
  22. Bojar RM. Manual of Perioperative Care in Adult Cardiac Surgery. 6th ed. Oxford: Wiley Blackwell; 2021.
  23. Stockley RA, Mannino D, Barnes PJ. Burden and pathogenesis of chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2009;6(6):524-6. doi: 10.1513/pats.200904-016DS.
  24. Huffmyer JL, Groves DS. Pulmonary complications of cardiopulmonary bypass. Best Pract Res Clin Anaesthesiol. 2015 Jun;29(2):163-75. doi: 10.1016/j.bpa.2015.04.002.
  25. Puruhito P. Primary textbook of cardiothoracic surgery. Surabaya: Airlangga University Press; 2013
  26. Nissinen J, Biancari F, Wistbacka JO, Peltola T, Loponen P, Tarkiainen P, Virkkilä M, Tarkka M. Safe time limits of aortic cross-clamping and cardiopulmonary bypass in adult cardiac surgery. Perfusion. 2009;24(5):297-305. doi: 10.1177/0267659109354656.
  27. Firoozabadi MD, Ebadi A, Sheikhi MA. Extubation time and postoperative blood pressure in CABG patient. Bali Med J. 2017;6(1):186-91. doi:

How to Cite

Wiratama, S., Sembiring, Y. E. ., & Setiawan, P. . (2024). Perioperative factors of fast track extubation success following coronary artery bypass graft surgery: a literature review. Bali Medical Journal, 13(1), 452–457.




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Siddiq Wiratama
Google Scholar
BMJ Journal

Yan Efrata Sembiring
Google Scholar
BMJ Journal

Philia Setiawan
Google Scholar
BMJ Journal