Table 1 Daily cycling exemption and cycling termination criteria

Daily cycling exemptions

 Use of 4 or more inotropes or vasopressors

 Any increased titration of inotropic medication in the past 2 h

 Active myocardial ischemia as confirmed by bedside 12-lead electrocardiogram (ECG)

 Mean arterial pressure (MAP) < 60 mmHg or > 110 mmHg

 Heart rate < 40 bpm or > 140 bpm within the past 2 h

 New onset of uncontrolled atrial fibrillation with a rate greater than 130 beats/min

 Persistent SpO₂ less than 88%, or out of what is typical for the patient, within the last 2 h

 Use of neuromuscular blockade within the past 4 h

 Severe agitation, as measured by the Richmond Agitation and Sedation Scale (score > 2)

 Presence of an intra-aortic balloon pump or femoral sheath

 Insertion of a temporary pacemaker (transvenous pacemaker) or those who are paced externally with no underlying rhythm

 Unstable saphenous vein graft site(s)

 Change in goals of care to palliation

 Patient or proxy refusal

 Team perception that cycling is not appropriate despite lack of listed exemption criteria

Cycling termination criteria

 Sustained decrease in oxygen saturation of < 88% for > 2 min despite attempts to improve oxygenation (increasing FiO₂, tracheal suctioning)

 Patient or proxy refusal after 2 attempts at encouragement to continue

 Unplanned extubation or decannulation

 Dehiscence of saphenous vein graft incision site(s)

 Sudden onset of severe agitation (Richmond Agitation and Sedation Scale (score > 2))

 Concerns for new onset of cardiac ischemia as per continuous telemetry

 Sudden onset of cardiac arrhythmias (including bradycardia < 40 bpm, tachycardia > 140 bpm, atrial fibrillation, right or left bundle branch block, sustained ventricular tachycardia, ventricular fibrillation, bigeminy, trigeminy)

 Hypotension with a systolic blood pressure < 90 mmHg

 Accidental removal of any lines or tubes (i.e., chest tubes, Jackson-Pratt drain, arterial line)