ERAS Cardiac Program

The Enhanced Recovery After Cardiac Surgery (or ERAS Cardiac) Program is a new approach to improving a child’s recovery after congenital heart surgery.

We think of it as a journey that begins before surgery by fully preparing you and your child for the procedure and continues at the hospital with helpful strategies. When your child returns home, we will closely monitor their recovery with an early virtual visit and patient-reported outcomes surveys, in addition to routine follow-up care from your primary team. We will guide you every step of the way!

Our goal is to help your child recover better and faster from heart surgery. At Boston Children’s, we use techniques and special evidence-based recommendations that lessen pain, lower complications, decrease time spent in the hospital, and improve patient and family satisfaction.

Our evidence-based guidelines are useful for patients undergoing many types of congenital heart surgery outside of the newborn period — including procedures for atrial septal defect (ASD), ventricular septal defect (VSD), coarctation of the aorta, and vascular rings — and certain types of valve repairs or replacement. Click here to learn about all of the procedures that incorporate ERAS.

Ask your doctor and surgeon about the ERAS Cardiac Program and if it’s appropriate for your child.

The ERAS Cardiac Journey

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Click each circle to learn about your child’s path to recovery after cardiac surgery at Boston Children’s.

Before surgery

Your child’s journey starts at home and with a preoperative appointment in the cardiology clinic that will prepare you and your child for surgery.

Day of surgery

We encourage your child to avoid prolonged fasting and instead drink clear fluids up to one hour before surgery. You will receive specific recommendations at the time of your clinic appointment.

During surgery

We use a combination of medications and approaches to reduce pain and discomfort during and after surgery. Depending on the type of surgery, smaller incisions may be used. We also use blood conserving techniques.

After surgery

Your child will go to the Cardiac Intensive Care Unit (CICU) and then the Acute Cardiac Care Unit (ACCU) where we will focus on:

Early removal of the breathing tube
Multimodal opioid-reducing pain regimen
Prevention of nausea
Early mobilization
Removal of tubes, catheters, and IVs
Return to a normal diet

Follow-up

Once you are home, there will be an early virtual follow-up visit. We will monitor your child’s recovery through electronic surveys, and send you a satisfaction survey.

What strategies are used by the ERAS Cardiac Program?

Our goal is to help your child recover better and faster after heart surgery. To achieve that, we use four major strategies:

Strategy 1: Avoiding prolonged fasting

Fasting can increase the body’s stress response and lead to dehydration, two things we want to avoid prior to a major surgery. That’s why the night before and morning of surgery, we recommend drinking Pedialyte, clear juices (like apple juice), or a clear sports drink. We will provide age-specific recommendations for your child in the preoperative clinic.

Strategy 2: Multiple approaches to treat pain

We believe the simultaneous use of different types of medications reduces pain and discomfort during and after surgery, and it leads to less reliance on opioids. The medications may include local anesthetics, acetaminophen (Tylenol), and non-steroidal anti-inflammatory drugs (NSAIDs). We continue to use opioids for acute, moderate, or severe pain.

Research has shown that reducing the amount of opioids that a patient receives, while managing their pain with other methods and medications, helps recovery. How does this work? Reducing opioids not only improves your child’s lung function, but it also helps digestion return to normal sooner after surgery. This means your child may experience less nausea, vomiting, and constipation, and they can return to a normal diet as soon as possible.

We partner with our colleagues from the Department of Anesthesiology, Critical Care, and Pain Medicine to develop new techniques and strategies to treat pain during and after surgery.

Strategy 3: Early extubation

Once surgery is complete and your child is doing well, we will remove the breathing tube. The removal of the breathing tube is known as extubation, and this may happen either in the operating room or in the Cardiac Intensive Care Unit (CICU) soon after the procedure is completed. As soon as it is safe to do so, we will also remove other tubes, catheters, and IVs. These steps reduce your child’s pain and discomfort and allow them to get out of bed easier.

Strategy 4: Early mobilization

Getting out of bed early after surgery has many benefits for your child. They breathe better, the drainage from their chest tubes improves, their gut function returns to normal faster, and they are at a lower risk to develop blood clots.

Early on, your child’s nurse will help accompany you and your child on a walk. Our goal is to have your child up and moving at least three times a day. Once it is safe to do so, you and your child can walk without assistance. You can make walking fun by checking out our playrooms, and by exploring our many gardens while on your recovery pathway. The Wishingstone Garden is just outside the Hale Family Building. The Berenberg Garden is inside the main hospital building, on the first floor. Other interior gardens are on floors 8 and 10 of the Hale building. And you can take in amazing views of Boston from gardens on the rooftops of the Hale and main hospital buildings.

The Wishingstone Garden atop the Hale Family Building includes benches for sitting.

The 10th floor at Hale also features an indoor garden.

Hale includes multiple playrooms for children who are staying at the hospital or who are visiting friends or family.

What happens when your child goes home after surgery?

After you go home, ERAS Cardiac follows your child’s recovery progress. We will schedule a virtual follow-up appointment about five to 10 days after discharge to monitor your child’s recovery and pain control, and follow healing of the wound. You will also have an in-person follow-up by your primary team, including your pediatrician and cardiologist.

You will receive automated reminders asking you to complete three brief online surveys with a few questions. Your voluntary responses help provide us with a better understanding of how your child is recovering. Your responses will be shared with your care team at Boston Children’s, but please note the site is not monitored 24/7 and we won’t immediately see your survey. If you have any questions or concerns, please contact your care team directly. For urgent health issues or emergencies, call 911 or go to the nearest emergency room.

Finally, to make sure we continue to deliver the best possible care for your child, please let us know what we have done well and how we can improve when you get a satisfaction survey from Boston Children’s. Remember, we are on this journey together!