Cardiopulmonary Exercise Testing — A Survey of Current Use in England

Abstract

Cardiopulmonary exercise testing (CPET) is an objective method of evaluating integrated cardiopulmonary function. Increasingly, it is being used for perioperative risk assessment. This survey was performed between October and December 2008 to identify where and how CPET is being used for perioperative risk assessment in England. Direct telephone contact was made with the Department of Anaesthesia in 154/173 (89%) of NHS Trusts in England in order to ascertain the availability of a CPET service. One hundred and fifteen (66%) Trusts confirmed whether or not they have a CPET service −30 (17%) Trusts have a CPET service and 12 (7%) are in the process of setting one up. These Trusts were sent a nine-question survey, which was completed by 15 Trusts. Criteria for selecting patients for CPET testing included type of surgery, age and co-morbidities. All trusts use anaerobic threshold (AT) values to identify patients at risk of adverse outcome, though many also used additional variables including peak oxygen consumption, ventilatory equivalents for carbon dioxide, ventilatory equivalents for oxygen, oxygen pulse, oxygen consumption/power slope and breathing reserve. Different numerical threshold values were used in different centres. Patients identified as high risk were managed in a variety of ways, including referral for specialist advice, modifying or cancelling surgery, modified perioperative care and augmented postoperative care (in a level 2 or 3 environment). This survey clearly highlights significant inconsistency in the use of CPET for perioperative risk assessment and suggests that some standardisation of practice may be of value.

Cardiopulmonary exercise testing, prehabilitation, and Enhanced Recovery After Surgery (ERAS)

“…The use of CPET in the perioperative setting has increased rapidly in the UK over the last decade. Survey data from the UK suggest that the number of hospitals using CPET for evaluation of perioperative risk has risen from 17% in 2008 74 to 32% in 2011, 75 and anecdotally, it is probably 40-50% in 2014. In general, perioperative CPET tests were requested by surgeons or anesthetists and conducted by anesthetists, but clinical arrangements varied across institutions.…”

Cardiopulmonary exercise testing for the evaluation of perioperative risk in non-cardiopulmonary surgery

“…Consequently, these three variables are used most frequently to stratify risk for non-cardiopulmonary surgery 6. For more detailed descriptions of CPET protocols and physiology the reader is directed to Wasserman et al 11 and the American Thoracic Society/American College of Chest Physicians statement on CPET 10…”

Validation of preoperative cardiopulmonary exercise testing-derived variables to predict in-hospital morbidity after major colorectal surgery

“…Cardiopulmonary exercise testing (CPET) is now performed widely before surgery and is considered to be the most objective and precise means of evaluating presurgical physical fitness. CPET evaluates physical fitness under stress, mimicking major surgery.…”