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

Two-thirds of patients experience low blood pressure during surgery, and this can cause harm, particularly in older people who may also be frail. 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. We will perform a detailed review of the current research in this area and publish a summary of our findings (systematic review). Using a national survey and interviews, we will ask clinicians about their current practice to understand what may help or hinder them from changing to continuous blood pressure monitoring. Then, we will recruit ~100 frail patients over 65y needing surgery for a broken hip into a small preliminary (feasibility) study. Patients will be allocated to continuous or 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. Study design has been informed by a recent Royal College of Anaesthetists project, which had significant PPI contributions and was developed with input from the RCoA PPI group, our PPI co-applicant and focus group work with carers and the public.