No restriction of oral food intake prior to nonemergent cardiac catheterization is as safe as the current traditional NPO [nothing by mouth] strategy, results from a large, single-center, randomized controlled trial showed.
According to lead investigator Abhishek Mishra, MD, NPO after midnight has been a standard practice before major surgery requiring general anesthesia since Mendelson Syndrome was first described in 1946.
"The rationale for keeping NPO after midnight has been to keep the stomach empty, to reduce gastric contents and acidity which would reduce emesis and eventually reduce the risk of aspiration," Dr. Mishra, a cardiologist at the Heart and Vascular Institute at Vidant Health in Greenville, N.C., said at the at the Society for Cardiovascular Angiography & Interventions virtual annual scientific sessions.
"The rationale of NPO in the setting of cardiac catheterization is to reduce the risk of aspiration, and more so, of a patient needing emergent cardiac surgery," Dr. Mishra added. "The clinical question was, do we really need to keep our patients NPO prior to elective cardiac catheterization? So far, no large randomized study has been done to answer this question."
To find out, Dr. Mishra and colleagues carried out CHOW NOW (Can We Safely Have Our Patients Eat With Cardiac Catheterization Nix or Allow), a single-center, prospective, randomized, single-blinded study that compared the safety of a nonfasting strategy with the current fasting protocol strategies in 599 patients who underwent nonemergent cardiac catheterization at The Guthrie Clinic/Robert Packer Hospital in Sayre, Pa.
Patients in the fasting group were instructed to be NPO after midnight, but could have clear liquids up to 2 hours prior to the procedure, while those in the nonfasting group had no restriction of oral intake, irrespective of time of cardiac catheterization. The primary outcome was a composite of aspiration pneumonia, preprocedural hypertension, preprocedural hypoglycemia or hyperglycemia, incidence of nausea/vomiting, and contrast-induced neuropathy. Secondary outcomes included total cost of the index hospitalization, patient satisfaction via a questionnaire containing seven questions, and in-hospital mortality.
Of the 599 patients, 306 were assigned to the standard fasting group and the remaining 293 to the nonfasting group. Their mean age was 67 years, 45% were on a proton pump inhibitor or H2 blockers, and 33% had diabetes. In addition, 40% had acute coronary syndrome, and 23% underwent percutaneous intervention.
The researchers observed no statistically significant difference in the primary or secondary outcomes between the study groups. In the nonfasting group, 11.3% of patients met the primary endpoint, compared with 9.8% of the patients in the standard fasting group (P = .65). In addition, the nonfasting strategy was found to be noninferior to the standard fasting strategy for the primary outcome at a noninferiority margin threshold of 0.059.
Dr. Mishra and colleagues observed no differences between the standard fasting and nonfasting groups with respect to in-hospital mortality (0.3% vs. 0.7%, respectively; P = .616), patient satisfaction score (a mean of 4.4 vs. a mean of 4.5; P = .257), and mean total cost of hospitalization ($8,446 vs. $6,960; P = .654).
"In this randomized, controlled trial, we found that there was no significant difference in the rate of overall adverse events with an approach of unrestricted oral intake prior to cardiac catheterization compared to strict fasting, and it was associated with better patient satisfaction and lower cost of care, especially for hospitalized patients," concluded Dr. Mishra, who conducted the research during his fellowship at The Guthrie Clinic.
He acknowledged certain limitations of the trial, including the fact that results are applicable only to cardiac catheterization procedures, including coronary angiographies, percutaneous coronary interventions, and left heart catheterizations. "These results are not applicable to certain high-risk coronary procedures that required the use of a large-bore access or any valve procedures," he said.
One of the session's invited panelists, SCAIPresidentCindy L. Grines, MD, said that she and other interventional cardiologists have "gone around and around" on the issue of NPO prior to nonemergent cardiac catheterization. "I actually let my patients get fluids up until the time they're put on the cath lab table," said Dr. Grines, chief scientific officer of the Northside Cardiovascular Institute in Atlanta. "I haven't been giving them solid food like this, though."
Another panelist, Timothy D. Henry, MD, said that in his clinical experience, "patients don't like being NPO, and I think we've all seen cases where patients are actually volume-depleted in the morning." Dr. Henry, medical director of The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital in Cincinnati, pointed out that most NPO policy "is not dictated by us as interventional cardiologists; it's dictated by hospital policies or by anesthesiologists. Will [the results of this study] change what we do?"
The Donald Guthrie Research Foundation funded the study. Daniel P. Sporn, MD, FACC, was the study's principal investigator. Dr. Mishra reported having no financial disclosures.
Society for Cardiovascular Angiography & Interventions (SCAI) 2020 Scientific Sessions: Abstract 11758.
Doug Brunk can be reached at dbrunk@mdedge.com. This article originally appeared on MDedge.
For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube.
Read the rest here:
To Fast or Not to Fast Before Elective Cardiac Catheterization - Medscape
- Home - MedStar Heart & Vascular Institute - April 16th, 2018 [April 16th, 2018]
- Guidelines for Standards in Cardiac Surgery - April 16th, 2018 [April 16th, 2018]
- Cardiac Surgery - University of Ottawa Heart Institute - June 16th, 2018 [June 16th, 2018]
- Cardiac Surgery | UNC Medical Center, Hospitals Chapel ... - June 18th, 2018 [June 18th, 2018]
- Heart Surgery | Seattle Childrens Hospital - June 18th, 2018 [June 18th, 2018]
- Pediatric Cardiac Surgery | CHKD | Norfolk, VA - June 18th, 2018 [June 18th, 2018]
- Cardiac Surgery | McLaren Port Huron - July 4th, 2018 [July 4th, 2018]
- CardioVascular Thoracic Institute (CVTI) | The most ... - July 23rd, 2018 [July 23rd, 2018]
- Top Cardiac Surgery COST in India| Benefit - IndianHealthGuru - July 27th, 2018 [July 27th, 2018]
- Cardiac Surgery - Atrial Septal Defect - August 6th, 2018 [August 6th, 2018]
- Cardiac Surgery | Stony Brook Medicine - August 6th, 2018 [August 6th, 2018]
- Cardiac Surgery in the Adult Fifth Edition: Lawrence H. Cohn ... - August 6th, 2018 [August 6th, 2018]
- Pioneers of Cardiac Surgery: 9780826515940: Medicine & Health ... - August 6th, 2018 [August 6th, 2018]
- Cardiovascular Surgery Department | Cleveland Clinic - August 6th, 2018 [August 6th, 2018]
- Cardiac Surgery - Massachusetts General Hospital, Boston, MA - September 19th, 2018 [September 19th, 2018]
- Cardiac Surgery | Surgery | UC Cincinnati College of ... - September 25th, 2018 [September 25th, 2018]
- Cardiothoracic surgery - Wikipedia - September 25th, 2018 [September 25th, 2018]
- Cardiac Surgery | NorthShore - September 25th, 2018 [September 25th, 2018]
- Open Heart Surgery - Cardiac Surgery - University of ... - September 25th, 2018 [September 25th, 2018]
- Heart Surgery | Cleveland Clinic - September 25th, 2018 [September 25th, 2018]
- Cardiac Surgery - Ventricular Assist Devices (VAD) - October 4th, 2018 [October 4th, 2018]
- VCSQI | Virginia Cardiac Services Quality Initiative ... - October 12th, 2018 [October 12th, 2018]
- Cardiac Surgery | Boston Medical Center - October 15th, 2018 [October 15th, 2018]
- Cardiac Surgery | WVU Heart and Vascular Institute - November 10th, 2018 [November 10th, 2018]
- Cardiac Surgery - Heart Valve, Bypass | GW Hospital - November 13th, 2018 [November 13th, 2018]
- Cardiac Surgery - Department of Surgery - University of ... - November 29th, 2018 [November 29th, 2018]
- Cardiac Surgery - Jersey Shore University Medical Center - December 7th, 2018 [December 7th, 2018]
- Blunt Cardiac Injury - The American Association for the ... - December 20th, 2018 [December 20th, 2018]
- Minimally invasive cardiac surgery - Wikipedia - December 20th, 2018 [December 20th, 2018]
- Heart Surgery | Private cardiac specialists in London ... - December 20th, 2018 [December 20th, 2018]
- Cardiac Surgery - Waterbury Hospital - December 20th, 2018 [December 20th, 2018]
- Cardiac surgery - Wikipedia - December 25th, 2018 [December 25th, 2018]
- Heart Surgery | Memorial Healthcare System - December 31st, 2018 [December 31st, 2018]
- A Step-By-Step Look at Open Heart Bypass Surgery - December 31st, 2018 [December 31st, 2018]
- Cardiac Surgery - Erlanger - December 31st, 2018 [December 31st, 2018]
- Inova Cardiac and Thoracic Surgery | Northern VA & DC - Inova - March 6th, 2019 [March 6th, 2019]
- Cardiac Surgery | Heart and Vascular Center | Dartmouth ... - March 13th, 2019 [March 13th, 2019]
- Cardiovascular Medicine and Cardiac Surgery - April 1st, 2019 [April 1st, 2019]
- Minimally invasive heart surgery - Mayo Clinic - April 3rd, 2019 [April 3rd, 2019]
- Home > Cardiac Surgery | Surgery | Yale School of Medicine - April 16th, 2019 [April 16th, 2019]
- Heart and Vascular Care Services - UR Medicine, University ... - April 18th, 2019 [April 18th, 2019]
- Welcome! | LHSC - April 20th, 2019 [April 20th, 2019]
- Cardiac Surgery | Department of Surgery | The University ... - April 20th, 2019 [April 20th, 2019]
- Coronary bypass surgery - Mayo Clinic - April 23rd, 2019 [April 23rd, 2019]
- Cardiovascular Surgery - Overview - Mayo Clinic - April 23rd, 2019 [April 23rd, 2019]
- Cardiac Surgery | McLaren Health Care - April 23rd, 2019 [April 23rd, 2019]
- Volunteer opens heart to his faith after healing cardiac ... - April 23rd, 2019 [April 23rd, 2019]
- Heart Surgery - UChicago Medicine - April 27th, 2019 [April 27th, 2019]
- Heart Surgery | UM St. Joseph Medical Center - May 13th, 2019 [May 13th, 2019]
- Cardiac Surgery - Billings Clinic - May 13th, 2019 [May 13th, 2019]
- Cardiology and Cardiac Surgery - Chicago Cardiologists and ... - May 23rd, 2019 [May 23rd, 2019]
- Cardiac Surgery | Michigan Medicine | University of Michigan - September 11th, 2019 [September 11th, 2019]
- Guidelines for Perioperative Care in Cardiac Surgery ... - September 11th, 2019 [September 11th, 2019]
- Cannula Market To Flourish And Reach USD 433 Million By 2025 - ZMR News Network - October 4th, 2019 [October 4th, 2019]
- Heart Health: Dr Panda says one should never give up on a patient - Republic World - October 4th, 2019 [October 4th, 2019]
- Minimally Invasive Surgery Market 2024 By Manufacturers, Investment Feasibility, Cost Structure And Swot Analysis - The Washington Observer - October 4th, 2019 [October 4th, 2019]
- Michael Schumacher health latest: What is stem cell therapy and how will it help Schumi? - Express.co.uk - October 4th, 2019 [October 4th, 2019]
- Cooperative insurance: Novel financing model aims to deliver healthcare to the middle-class segment - The Hindu BusinessLine - October 4th, 2019 [October 4th, 2019]
- Optimism Linked to Lower Risk of Cardiovascular Events and Death - Cath Lab Digest - October 4th, 2019 [October 4th, 2019]
- Global Cardiac Surgery Devices Market 2019 Innovative Trends and Insights Research upto 2024 - Markets Gazette - October 4th, 2019 [October 4th, 2019]
- Abiomed Receives FDA PMA Approval for Impella 5.5 With SmartAssist - Diagnostic and Interventional Cardiology - October 4th, 2019 [October 4th, 2019]
- Economics of Cochlear Implant Utilization : The Hearing Journal - LWW Journals - October 4th, 2019 [October 4th, 2019]
- How to Keep the Weight Off After Bariatric Surgery - Health Essentials from Cleveland Clinic - October 4th, 2019 [October 4th, 2019]
- Heart Lung Machine Market to Upsurge at 6.13% CAGR by 2023, Owing to Increasing Demand From the Healthcare Sector: Radiant Insights, Inc. - PRNewswire - October 4th, 2019 [October 4th, 2019]
- Annadale toddler born with rare condition is fighting for her life - SILive.com - October 4th, 2019 [October 4th, 2019]
- Ocala Health earns distinction, ranks among top within HCA open heart programs - Ocala News - October 4th, 2019 [October 4th, 2019]
- External Validation Of The Surgical Mortality Probability Model (S-MPM | TCRM - Dove Medical Press - October 4th, 2019 [October 4th, 2019]
- CytoSorb Removal of Ticagrelor Intraoperatively Results in Projected Cost Savings of Approximately $5,000 in Each Patient Undergoing Emergency Cardiac... - October 4th, 2019 [October 4th, 2019]
- Transcatheter Tricuspid Fix Bests Meds Alone in Early Results - Medscape - October 15th, 2019 [October 15th, 2019]
- Senior Lecturer/Associate Professor in Medical Statistics job with UNIVERSITY OF BRISTOL | 183393 - Times Higher Education (THE) - October 15th, 2019 [October 15th, 2019]
- Complicated surgery at NICVD saves life of nine-year-old boy - The News International - October 15th, 2019 [October 15th, 2019]
- Angion Announces Several Strategic Additions to its Management Team to Support the Future Development and Commercialization of ANG-3777 - Yahoo... - October 15th, 2019 [October 15th, 2019]
- 'Sky is the limit' for heart treatment without invasive surgery - Ottawa Citizen - October 15th, 2019 [October 15th, 2019]
- Executive Profile: Dr. David Anschel - Long Island Business News - October 15th, 2019 [October 15th, 2019]
- Heart surgeon and author reveals how he once set fire to patient - The Guardian - October 15th, 2019 [October 15th, 2019]
- Demolition paves way for heart, vascular center - Midland Daily News - October 15th, 2019 [October 15th, 2019]
- The basics of research | TNS - The News on Sunday - October 15th, 2019 [October 15th, 2019]
- Senior Lecturer/Associate Professor in Medical Statistics job with UNIVERSITY OF BRISTOL | 183345 - Times Higher Education (THE) - October 15th, 2019 [October 15th, 2019]
- Sparks, Accusations Fly Over Conduct of EXCEL Trial - Medscape - October 15th, 2019 [October 15th, 2019]
- More Heart Valve Patients May Choose Minimally Invasive Procedure - Newswise - October 15th, 2019 [October 15th, 2019]