Background: Early extubation after cardiac surgery results in better postoperative outcomes but the optimal time for extubation remains unclear. Premature extubation may lead to unplanned reintubation that may result in adverse outcomes. The present study was undertaken to compare preoperative and operative risks and outcomes of patients with prolonged intubation >48 hours and reintubation after cardiac surgery. Aims: This is a retrospective chart review of 1259 patients who had cardiac surgery at a community hospital. After excluding patients with either operating room death, extubation <48 hours without reintubation or extubation >48 hours with reintubation, the final sample included 83 patients (6.6%) requiring reintubation after extubation in <48 hours and 100 (8.0%) with prolonged intubation without requiring reintubation. Results: Bivariate analyses revealed few statistically different preoperative and operative risks between patients with reintubation and prolonged intubation. Reintubation patients were older (p = .033) and had lower body mass index (p = .000), higher preoperative hematocrit (p = .021), and more chronic kidney disease stages >2 (p = .046) but lower odds for intra-aortic balloon pump (p = .006) and emergency surgery (p = .005). Reintubation led to worse postoperative outcomes than prolonged intubation: more acute kidney injury stage 1-3 (p = .014), coma/encephalopathy (p = .004), postoperative transfusion (p = .003), increased intensive care unit length of stay (p = .001) and hospital mortality (p = .007). Based on binary and ordinal logistic regression analyses, the differences in preoperative and operative risks were either inconsistent or trivial contributors and reintubation appears to make the largest independent contribution to poor postoperative outcomes. Conclusion: While early extubation remains the goal, patients with marginal weaning readiness may benefit from more recovery time before extubation. This study suggests that premature extubation may increase unplanned reintubation that could adversely affect postoperative outcomes after cardiac surgery.

Background: How quickly percutaneous coronary intervention is performed in patients with a ST-elevation myocardial infarction (STEMI) is a core quality measure, reported as door-to-balloon (D2B) time in minutes. Aims: This retrospective study of 1193 patients was undertaken to explore how well six hospitals in a large healthcare system achieved time from the emergency department (ED) to the first ECG <10 minutes and D2B time ≤90 minutes. Methods: STEMI coordinators provided shelved data collected between 1-1-2016 and 8-31-2018. D2B times were available for 818 patients. The overall median time from the ED to the first ECG was 4 minutes and all hospitals achieved median times less than 10 minutes. There was a significant difference between the hospital with the highest (88%) and lower percentage of patients (79%) attaining the recommended time from the ED to the first ECG <10 minutes (p<0.025). The overall median D2B time for the entire sample was 63 minutes and the difference between D2B time among hospitals was significant (p<0.001). Collectively, the six hospitals achieved a D2B time <90 minutes well above the recommended goal by the American Heart Association (87.8% vs 75% respectively, p<0.001). The most compelling finding was that field STEMI activation with direct patient transportation to the cardiac catheterization laboratory(CCL) resulted in significantly shorter D2B times than ED activation (p<0.001). Patients with D2B time <90 minutes had a lower mortality than those with D2B time >90 minutes (5.3% vs 19.0% respectively, p<0.001). Conclusion: Achieving D2B time <90 minutes has a significant impact on mortality associated with STEMI. Field STEMI activation with direct patient transport to the CCL significantly shortened D2B time. Further study is needed to assess the benefit of close collaboration between hospital and Emergency Medical Service personnel to implement this mode of patient transportation to the CCL to improve STEMI care.