Ultra-fast-track extubation is associated with reduced EEG abnormalities and improved early outcomes after pediatric cardiac surgery: a propensity score-matched cohort study.

Ultra-fast-track extubation (UF) improves postoperative recovery in cardiac surgery, but its cerebral effects remain unclear. This study compared UF and conventional extubation (CE) in children with congenital heart disease (CHD) after cardiopulmonary bypass (CPB), focusing on electroencephalographic (EEG) abnormalities during the initial 48 postoperative hours. Of 352 CHD patients undergoing CPB, 57 UF and 295 CE cases were propensity score-matched (PSM) (1:2), yielding 55 PSM-UF and 89 PSM-CE subjects. Intra/postoperative EEGs were analyzed for background abnormalities (sleep-wake cycle) and epileptiform discharges (seizures, spikes/sharp waves). Clinical parameters including STS-EACTS mortality risk and CPB duration were balanced. The PSM-UF group demonstrated milder background abnormalities (P = 0.02) and lower incidence of unresolved abnormalities at 48 h (7% vs. 24%, P = 0.009). Epileptiform activity was significantly reduced (0% vs. 11% seizures, P = 0.007; P = 0.008 for spikes/sharp waves). UF patients showed superior cerebral oxygen saturation (ScO2, P < 0.0001), reduced vasopressor requirements (P < 0.0001), and shorter hospital stays (2.0 ± 1.4 vs. 6.0 ± 5.6 days, P < 0.0001) with comparable CICU stay reductions (9.6 ± 4.1 vs. 13.3 ± 8.5 days, P = 0.002). UF following pediatric cardiac surgery correlates with attenuated EEG abnormalities and enhanced early recovery, supporting its neuroprotective benefits in CHD patients.