ERAS Overview

Building a successful ERAS Cardiac program involves bringing together many aspects of perioperative care. This module reviews some high-level concepts of ERAS, as well as an example of Dr. Gerdisch's current comprehensive ERAS program.

A Cardiac Enhanced Recovery Program (ERP) incorporates various key features designed to optimize the patient's recovery process after heart surgery. Here is a summarized list of these features:

Preoperative Phase:

Patient Education:

• Informing patients about the procedure, expected recovery process, and their active role in recovery.

Nutritional Optimization:

• Ensuring patients are nutritionally prepared for surgery to enhance healing and recovery.

Risk Factor Modification:

• Addressing and managing risk factors like diabetes, obesity, smoking, etc., to reduce complications.

Prehabilitation:

• Physical exercises and activities to improve the patient's physical condition before surgery.

Identification and treatment of preoperative anemia:

• Correcting anemia prior to surgery to reduce the physiological stress related to reduce option care and capacity while minimizing the need for blood transfusion.

Intraoperative Phase:

Minimally Invasive Techniques:

• Using minimally invasive surgical techniques to reduce trauma and hasten recovery.

Optimal Anesthesia & Analgesia

• Choosing anaesthetic and multimodal analgesic agents that facilitate quick recovery, early extubation, and optimal pain relief (while minimizing side effects).

Goal Directed Therapy:

• Monitoring and managing fluids and hemodynamics, including while on cardiopulmonary bypass, to prevent fluid overload and organ dysfunction.

Reducing Surgical Site Infection:

• Applying a comprehensive bundle will reduce the degree of morbidity and mortality related to surgical site infections.

Postoperative Phase:

Early Mobilization:

• Encouraging patients to move and walk as early as possible to prevent complications like blood clots or respiratory issues.

Avoiding delays in removal of tubes, drains, and lines:

• By leaving tubes, drains, aligns in for only the shortest amount of time as required will facilitate early mobilization, reduce patient discomfort, and help prevent tube/drain/line related infections.

Multimodal analgesic:

• Optimizing postoperative comfort through a multimodal approach while minimizing side effects of common analgesic medications.

Nutritional Support:

• Ensuring patients receive adequate nutrition to support healing and recovery.

Multidisciplinary Care:

• Involving a team of specialized healthcare professionals to provide comprehensive care.

Other Key Components:

Standardized Protocols:

• Implementing evidence-based protocols to ensure consistency and quality of care.

Patient Engagement:

• Actively involving patients in their recovery process to improve outcomes.

Outcome Measurement:

• Collecting data on patient outcomes to continually refine and improve the program.

Overall Goal of ERAS Cardiac:

The overarching goal is to enhance the recovery of patients undergoing cardiac surgery by minimizing surgical stress responses, reducing complications, and shortening hospital stay, thereby improving overall patient outcomes and experiences. Each program may be tailored to the individual patient’s needs, and it incorporates a multidisciplinary approach involving surgeons, anesthesiologists, nurses, dieticians, physical therapists, and others.

This summary was written with assistance from artificial intelligence. All text was reviewed, edited, and supplemented by the listed editor(s). Reference: OpenAI. (2023). ChatGPT (Sept 25 version) [Large language model]. https://chat.openai.com/chat

ERAS Cardiac VTC Disclaimer:

The VTC, and all included content, is intended to inform ERAS Cardiac Members in a multitude of topics related to enhanced recovery. The information included has been provided by other enhanced recovery experts and should be used for educational purposes only. It is not intended to describe, recommend, or suggest any specific medical practice or intervention, nor should it be considered as formal medical advice or consultation. The ERAS Cardiac Society cannot guarantee that the information on the VTC is accurate or complete in every respect. Therefore, ERAS Cardiac Society is not responsible for any errors or omissions in the content, or medical results that occur with the application of the information obtained while using the VTC. All healthcare professionals should continue to use sound clinical judgment and prescribe therapies based on the best medical knowledge at their disposal.

All the material presented on the VTC is the intellectual property of the ERAS Cardiac Society, its contributors, and its sponsors. Unless explicitly stated, the information, images, audio, video, and other content may not be reproduced (in whole or in part) in any way without the written permission of the ERAS Cardiac Society.

If you have any questions or comments about the ERAS Cardiac VTC, please email: VTC@erascardiac.org