Cardiopulmonary Exercise Testing (CPEX)

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Cardiopulmonary Exercise Testing (CPEX)

• Dr David Timbrell
• Vascular Anaesthetic Fellow
• AAA QIP Meeting, Haywards Heath
• 30 March 2012

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CPEX at Frimley

• Established Summer 2010
• Initially colorectal
• Increasing vascular caseload last 6-12 months
• 3 cases/day
• 1hr each
• History, test, feedback

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AAA Caseload

• 1/1/11 31/1/12 (13 months)
• National Vascular Database

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AAA Caseload
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Who to CPEX?

• All planned Open repair
• Patients ? Open, ? EVAR
• EVAR according to Red, Amber, Green score
• Not capacity for all EVAR

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CPEX Caseload

• 53 AAA patients since established
• 48 planned open/unsure
• 2 TEVAR
• 3 planned EVAR
• 20 proceeded to open
• 12 proceeded to EVAR
• Remaining 21 patients
• 3 Referred to St Georges
• 12 Surgery awaited
• 6 Not to proceed, deceased etc

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Can CPEX help us to fast-track Open AAA patients?

• 11/20 patients AT gt 11 ml/kg/min
• What support was required?

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Outcomes ITU Support
Adv. Resp Basic Resp Adv. Cardiac Basic Cardiac Renal
AT gt 11 (ml/kg/min) 1 5 0 11 0
AT lt 11 (ml/kg/min) 2 3 2 9 0

• Median discharge day 3 vs 4

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Future Plans

• CPEX for all Open AAA patients
• Vascular Anaesthesia Clinic
• For all EVAR pts
• ? Extended recovery/HDU for elective open AAA pts
  with AT gt 11
• Assuming no complications