Cardiopulmonary Exercise Testing (CPEX)

1. Cardiopulmonary Exercise Testing (CPEX) Dr David Timbrell Vascular Anaesthetic Fellow AAA QIP Meeting, Hayward’s Heath 30 March 2012

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

3. AAA Caseload • 1/1/11 – 31/1/12 (13 months) • National Vascular Database

4. AAA Caseload

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

6. 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 George’s • 12 Surgery awaited • 6 Not to proceed, deceased etc

7. Can CPEX help us to fast-track Open AAA patients? • 11/20 patients AT > 11 ml/kg/min • What support was required?

8. Outcomes – ITU Support • Median discharge day 3 vs 4

9. 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 > 11 • Assuming no complications