Evaluation of the Clinical Impact of Ultra Fast-Track in Patients Undergoing Cardiac Surgery

Study Overview
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Brief Summary
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Single center randomized clinical trial. The main aim is to demonstrate the superiority at the clinical level of the ultra fast-track programs versus conventional early postoperative extubation in patients undergoing cardiac surgery.

Detailed Description
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The study is aimed to compare clinical superiority of ultra fast-track versus conventional early postoperative extubation in patients undergoing cardiac surgery in our center. The estimated sample size is 382 patients. They will be randomized 1:1 to any of the two arms of the study (ultra fast-track vs. fast-track). The randomization will be stratified according the type of surgery performed. The period of recruitment will start in January 2023 and is supposed to finish by December 2024 or earlier. The main outcomes of the study will be measured 1 year after the procedure.

Official Title
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Evaluation of the Clinical Impact of Ultra Fast-Track in Patients Undergoing Cardiac Surgery Versus Conventional Extubation (CARDU-FAST)

Conditions
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Cardiac Disease, Surgery, Anesthesia

Intervention / Treatment
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* Behavioral: Ultra Fast-track


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients over 18 years of age. Patients with valvular, coronary or aortic heart disease with an indication for major cardiac surgery. The patient's desire to participate in the clinical trial verified by signing the informed consent. Exclusion Criteria: Pregnancy. Emergent surgery or cardiorespiratory arrest. Patient in preoperative cardiogenic shock, or in need of high-dose vasoactive support. Aortic arch procedures. Procedures in which hypothermia < 28ºC of temperature is expected during the intervention. Minor cardiac surgery procedures. Procedures with minimally invasive techniques without extracorporeal circulation (Transcatheter aortic valve implantation, Transcatheter mitral valve implantation, Minimally invasive mitral valve repair (TOP-Mini), Totally thoracoscopic MAZE procedure, Minimally invasive direct coronary artery bypass grafting). Implantation of circulatory assistance devices or ECMO (extracorporeal membrane oxygenation). Active endocarditis.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Single Group Assignment
Interventional Model Description: Randomized 1:1. Stratified by type of surgery (CABG, Valvular, Aorta)
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Ultra fast-track<br>Patients are extubated in the operating room after the procedure | Behavioral: Ultra Fast-track<br>* Patients are extubated in the operating room<br>|
| Active Comparator: Conventional extubation<br>Patients are extubated in the intensive unit care | Behavioral: Ultra Fast-track<br>* Patients are extubated in the operating room<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Determine the effect of Ultra Fast-track | Determine the effect of Ultra Fast-track on the occurrence of the composite outcome composed of all-cause mortality, respiratory complications (prolonged intubation over 24h, reintubation, or pneumonia) and AKIN-III (acute renal failure) in patients undergoing ultra fast-track and patients with conventional postoperative extubation. | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Procedural resources conpsumption | Comparison of operating room occupancy time (minutes), ICU stay and overall postoperative stay (days). | 1 year | 
| Differences in the need for high flow nasal oxygen therapy or non-invasive ventilation for >24h. | Comparison of the need for high flow nasal oxygen therapy or non-invasive ventilation for >24h after the procedure. | 1 year | 
| Differences in major bleeding or life-threatening bleeding. | Comparison of the event of major bleeding or life-threatening bleeding (VARC 2 definition). | 1 year | 
| Differences in neurological complication | Comparison of the incidence of neurological complication after the procedure. | 1 year | 
| Differences in the incidence of acute myocardial infarction. | Comparison of the incidence of acute myocardial infarction after the procedure. | 1 year | 
| Differences in the incidence of heart reoperation | Comparison of the reoperation rate after the procedure. | 1 year | 
| Differences in the incidence of infections rate. | Comparison of the incidence of infection that requires intravenous antibiotic therapy, which causes an increase in hospital stay or engage patient's life. | 1 year |