Randomized Evaluation of Operating Room Extubation After Cardiac Surgery

October 28, 2026 updated by: Lauren E Gibson, Massachusetts General Hospital

Randomized Evaluation of Operating Room Extubation Versus Intensive Care Unit Extubation After Cardiac Surgery

We are studying whether waking patients up and removing the breathing tube (also known as "extubation") in the operating room after cardiac surgery improves postoperative recovery without causing harm.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

This is a pragmatic, randomized controlled trial comparing OR extubation versus ICU extubation among adults undergoing elective cardiac surgery.

Study Type

Interventional

Enrollment (Estimated)

120

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Adults (age 18+) scheduled for elective cardiac surgery requiring cardiopulmonary bypass
  • Low perioperative risk defined as STS Predicted Risk of Mortality (PROM) ≤ 3% based on the latest STS Adult Cardiac Surgery Database (ACSD) Risk Calculator
  • Deemed appropriate for OR extubation preoperatively by the attending cardiac surgeon
  • Able to provide informed consent

Exclusion Criteria:

  • Underlying pulmonary disease requiring use of home supplemental oxygen
  • Pre-capillary pulmonary hypertension (mPAP ≥ 25 mmHg or PVR > 2 Wood units) on most recent right heart catheterization for any patient for which there is suspicion for pulmonary hypertension at the time of preoperative evaluation
  • Preoperative right ventricular dysfunction greater than mild on most recent echocardiogram
  • BMI ≥ 35
  • Obstructive sleep apnea with home CPAP or biPAP use or recommended use
  • Neuromuscular disease associated with respiratory muscle weakness including myasthenia gravis, Lambert-Eaton myasthenic syndrome, or muscular dystrophy
  • Airway abnormalities including tracheostomy, history of difficult mask ventilation, history of difficult intubation requiring fiberoptic rescue or multiple (>2) attempts, known anatomic abnormalities including limited mouth opening (< 3cm), severe micrognathia, tracheal stenosis, or tracheal compression due to mass or goiter

We will also exclude patients undergoing the following procedures:

  • Transplant surgery
  • Pulmonary thromboendarterectomy
  • Implantation of mechanical circulatory support including LVAD, Impella, intra-aortic balloon pump, RVAD, or ECMO

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: OR extubation

Extubation in the operating room (OR) at the conclusion of cardiac surgery
Procedure: OR extubation

Immediate extubation in the operating room (OR) at the conclusion of cardiac surgery
Placebo Comparator: ICU extubation

Extubation in the intensive care unit (ICU) within 6 hours of leaving the OR
Procedure: ICU extubation

Extubation in the intensive care unit (ICU) within 6 hours of leaving the operating room after cardiac surgery

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Hierarchical composite endpoint, ordered by clinical priority
Time Frame: 15 days postoperatively
  1. Death by postoperative day 15;
  2. Unplanned reintubation or cumulative mechanical ventilation > 12 hours from OR exit, assessed through 48 hours postoperatively;
  3. Days at home through postoperative day 15 (DAH-15). DAH-15 will be measured from the time of post-operative ICU admission and will subtract any time spent in a hospital (index hospitalization or readmission), rehabilitation center, or nursing facility.
15 days postoperatively

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Postoperative ICU length of stay
Time Frame: 30 days

Cumulative length of stay (hours) in an intensive care unit (ICU) following cardiac surgery
30 days
Postoperative hospital length of stay
Time Frame: 30 days

Length of index hospitalization (hours) following cardiac surgery
30 days
Use of non-invasive respiratory support
Time Frame: 48 hours

Use of non-invasive respiratory support such as biPAP, CPAP, or high flow oxygen after OR exit
48 hours

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Massachusetts General Hospital

Collaborators

Brigham and Women's Hospital

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

October 1, 2026

Primary Completion (Estimated)

April 1, 2027

Study Completion (Estimated)

June 1, 2027

Study Registration Dates

First Submitted

August 6, 2026

First Submitted That Met QC Criteria

August 6, 2026

First Posted (Actual)

August 11, 2026

Study Record Updates

Last Update Posted (Actual)

October 29, 2026

Last Update Submitted That Met QC Criteria

October 28, 2026

Last Verified

October 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2026P000935

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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