Strict Versus No Fasting Prior to Cardiac Catheterization: A Prospective Evaluation of Safety and Clinical Outcomes: Can We Safely Have Our Patients Eat With Cardiac Catheterization— Nix or Allow: The CHOW NOW Study
Abhishek Mishra, M.D., Guthrie Clinic/Robert Packer Hospital, Greenville, NC
Abhishek Mishra, M.D.1, Maninder Singh, M.D.2, Aadil Lodhi, M.D.2, Edo Kaluski, M.D., FSCAI2, Sudhakar Sattur, M.D.3 and Daniel P. Sporn, M.D.4, (1)Guthrie Clinic/Robert Packer Hospital, Greenville, NC, (2)Guthrie Robert Packer Hospital, Sayre, PA, (3)Robert Packer Hospital, Guthrie Health System, Sayre, PA, (4)Guthrie Clinic, Sayre, PA
Keywords: ACS, Adult Congenital Heart Disease (ACHD), Cath Lab Administration, Coronary and Quality
Background:
Currently, patients undergoing cardiac catheterization are kept nil per os (NPO) as no standard fasting protocol exists. No studies have examined safety of a no fasting strategy in these patients. The primary purpose of this study was to compare safety of a non-fasting (NF) strategy as compared to our current fasting protocol. We hypothesized that no restriction of oral intake is non-inferior to current practice of NPO after mid night protocol for patients undergoing non-emergent cardiac catheterization.
Methods:
A single center, prospective, randomized, single blinded study which compared these strategies at Guthrie/Robert Packer Hospital, Sayre PA. Fasting group was instructed to be NPO after midnight but could have clear liquids up to 2 hours prior to the procedure. NF group had no restriction or oral intake irrespective of time of cardiac catherization. The primary outcome was a composite of contrast induced nephropathy (CIN), peri procedural hypotension, aspiration pneumonia, nausea/vomiting, hypoglycemia and hyperglycemia. Secondary outcomes included assessment of patient satisfaction, in hospital mortality and total cost of index hospitalization.
Results:
A total of 599 patients (outpatients: n=305, inpatients: n=294) were randomized. Both groups had similar baseline characteristics. As compared to the fasting group (n=306), NF group (n=293) had similar rates of primary outcome (9.8% vs. 11.3% respectively, p=0.65) and was non-inferior to the fasting strategy at a threshold of 0.059. There was no significant difference in incidence of CIN (1.6% vs. 2.4%), peri-procedural hypotension (1.6% vs. 2.0%), aspiration pneumonia (none vs. 0.7%), nausea/vomiting (3.6% vs 5.1%), hyperglycemia (3.3% vs. 1.4%), or hypoglycemia (1.0% in both). More than 99% patients of both groups were discharged alive. There was no significant difference with regards to the patient satisfaction score and 30-day mortality. [fasting vs NF: 4.38±0.90 vs. 4.49±0.77 and 1.3% vs. 2.4% respectively, p=ns for both]. Cost of hospitalization was also similar in both groups.
Conclusions:
No restriction of oral intake prior to cardiac catheterization is as safe (non-inferiority threshold of 0.059) as current traditional NPO strategy.