CLINICAL PRACTICE

Several distinct areas of practice are active.  Physician led cardiac and respiratory services conduct tests evaluating diverse conditions including pulmonary hypertension, cardiac transplant, surgically corrected congenital heart disease, and unexplained breathlessness. Anaesthetists, sometimes in collaboration with physicians, provide Peri-operative risk evaluation using CPET.  In a minority of cases consultant clinical scientists provide CPET services for a variety of medical departments.

Probably a majority of tests in the UK are now conducted to assess clinical risk prior to elective major surgery,  An open session at the 2nd National Peri-operative CPET Meeting (2009) suggested that more than 10,000 tests per year are being conducted for this indication within the UK.   A recent survey identified more than 30 centres currently active in this area with a further 12 in the process of setting up services (2008, 66% response rate).  The majority of the peer reviewed literature relating to Peri-operative CPET now derives from UK centres.    The early enthusiasm for sub-maximal tests (a la Older) is increasingly being replaced by exercise to exhaustion. Several controversies remain: which patients to test, appropriate level of medical supervision, which variables to sue as risk criteria and how best to manage patients identified as high risk.

CONFERENCES, COURSES AND MEETINGS

The 3rd annual National Peri-operative CPET Meeting will take place in June with an anticipated attendance in excess of the 120 delegates in 2009.  The National organisation is developing rapidly with a new set of consensus guidelines in development.

Several courses cater specifically for the aspiring Peri-operative CPET practitioner. See:
www.ebpom.org and www.artp.org.uk.

There is also a small but active medical CPET community also meet regularly with a national meeting in September.

RESEARCH

Several nationally funded studies (National Institute of Health Research, Medical Research Council) are utilising CPET to evaluate diverse phenomena including activity in normal aging, recovery following intensive care, and the adverse effects of neo-adjuvent chemotherapy.  A multi-centre randomised controlled trial is currently underway testing the “Older” hypothesis that using CPET derived variables to determine postoperative care (intensive care vs. ward care) improves outcomes when compared with clinician judgement.

For further information please contact Dr Mike Grocott, CPEX International Board Member: mike.grocott@ucl.ac.uk