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 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

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 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

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