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

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

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

AAA Caseload

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

CPEX Caseload 53 AAA patients since established 20 proceeded to open 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

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

Outcomes – ITU Support Median discharge day 3 vs 4 Adv. Resp Basic Resp Adv. Cardiac Basic Cardiac Renal AT > 11 (ml/kg/min) 1 5 11 AT < 11 2 3 9 1 x Adv Resp pt with AT >11 – 5l intra-op blood loss. ie. No intra-op complications --- No invasive ventilation/inotropes Median discharge day 3 vs 4

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