Is Faster Always Better? Ultra-Fast-Track Versus Fast-Track Extubation in Adult Cardiac Surgery: A Comprehensive Meta-analysis With Meta-regression
In brief
Ultra-fast-track extubation halves 30-day mortality and saves 12 hours ICU time
A meta-analysis of 20 studies (~800,000 cardiac surgery patients) found that extubating in the operating room or within one hour reduced 30-day death risk by about 50% and shortened intensive-care stay by roughly 12 hours, with similar rates of reintubation and complications. The mortality advantage disappeared after adjustment, highlighting the need for careful patient selection and prospective trials.
- Journal
- Journal of cardiothoracic and vascular anesthesia (Q2)
- Published
- 11 June 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Kristine Santos, Neel Patel, Takumi Umibe, Toru Abo, Wataru Sakai, Kensei Oya, et al.
- PMID
- 42469073
- DOI
- 10.1053/j.jvca.2026.06.012
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (top studies of the week, 19 July 2026): SR/MA of RCTs, extubation timing after cardiac surgery
Abstract
OBJECTIVES: To compare the clinical outcomes of ultra-fast-track extubation (UFTE), defined as extubation in the operating room or within 1 hour postoperatively, versus fast-track extubation (FTE), defined as extubation within 6 hours in the intensive care unit [ICU]), in adult patients undergoing cardiac surgery. DESIGN: Systematic review and meta-analysis. SETTING: Studies identified from MEDLINE, Scopus, and the Cochrane Library. PARTICIPANTS: Adult patients undergoing cardiac surgery. INTERVENTIONS: Comparison of UFTE versus FTE. MEASUREMENTS AND MAIN RESULTS: Twenty studies including nearly 800,000 patients were analyzed. UFTE was associated with lower 30-day mortality (odds ratio [OR], 0.54), shorter ICU length of stay (LOS) (mean difference [MD], -12.27 hours), shorter hospital LOS (MD, -1.19 days), reduced stroke rate (OR, 0.85) and reduced readmission rate (OR, 0.64). Rates of reintubation, reoperation for bleeding, acute kidney injury, pneumonia, and atrial fibrillation were similar. In the minimally invasive cardiac surgery subgroup, UFTE was associated with lower reintubation risk (OR, 0.26), whereas in the coronary artery bypass grafting subgroup, only hospital LOS was reduced. In propensity-matched cohorts, mortality and reintubation were comparable, although ICU and hospital stays remained shorter with UFTE. Meta-regression identified male sex and baseline left ventricular ejection fraction as significant moderators of the mortality effect. CONCLUSIONS: UFTE appears safe in selected patients and is associated with improved efficiency and recovery, particularly reduced ICU and hospital LOS. However, the observed mortality benefit is not sustained after adjustment, suggesting an important role of patient selection and perioperative optimization. Prospective randomized trials are required to confirm these findings.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.