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The CAREFUL Study

The CAREFUL Study will investigate whether continuous monitoring of blood pressure during surgery can benefit patients who are high risk, particularly those who are older and living with frailty.

Careful

Full title

Continuous ARterial monitoring in Elderly and Frail patients for hip fractUre surgery to prevent Low blood pressure

Background

Two-thirds of patients experience low blood pressure during surgery, and this can cause harm (e.g. to the patient’s heart, kidneys or brain), particularly in older people who may also be frail (e.g. need aid with daily life).

We may be able to reduce the amount of low blood pressure a patient experiences by measuring their blood pressure continuously during surgery with a drip inserted in the wrist, rather than individual (intermittent) measurements with a blood pressure cuff (e.g. every 5 minutes).

Patients who have broken their hip are at particularly high risk of harm with surgery, as many are older and frail. In the UK, only around 1 in 10 of these patients receive continuous blood pressure monitoring. The other 90% may benefit from continuous monitoring, allowing early recognition and treatment of low blood pressure, ensuring a healthy supply of blood and oxygen to body organs.

However, there is currently limited research supporting this approach, meaning clinicians do not routinely do it.

What we are doing

Through three packages of work, we will aim to address the knowledge gap and help decide if a larger trial is required and practical.

  1. We will perform a detailed review of the current research in this area and publish a summary of our findings.
  2. Using a national survey and focus groups, we will ask clinicians about their current practice to understand what may help or hinder them from changing to continuous blood pressure monitoring in these high-risk patients.
  3. We will recruit 100 patients over 65 years old living with frailty and needing surgery for a broken hip into a small, feasibility study. Half of patients will be allocated to continuous, and the other half will be allocated to intermittent blood pressure monitoring during surgery. We will assess how practical the study is, record blood pressure measurements during surgery, complication rates and ask patients about their quality-of-life.

Chief investigator

Dr Andrew Kane

Co-chief investigator

Professor Gerard Danjoux

South Tees Hospitals NHS Foundation Trust

Funder

NIHR – Research for Patient Benefit (RfPB)

Current status

In set-up

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