Effect of Nothing by Mouth (NPO) on Cases of Cardiac Catheterizations

Since the inception of cardiac catheterization in the 1940s, “nothing by mouth” (NPO) has been the standard of care due to the variable risks of gastrointestinal discomfort caused by the chemicals in the procedure (Kern). However, as the operation has become safer and more contemporary, physicians and researchers alike are beginning to wonder if evidence for the NPO standard is sufficient for use in the modern day. Previous studies performed within the last decade supports the theory that the NPO standard is outdated by splitting groups of cardiac catheterization patients into smaller parts and assigning a fasting regimen to 1 group and no fasting limitations to the other. In every study performed, the difference in primary outcomes, including vomiting, aspiration pneumonitis, contrast-induced nephropathy, hypotension, and hypoglycemia, was negligible. 1 Bacus SB Parsons J Benatar J Somaratne J Webster M Parke R Fasting prior to cardiac catheterisation: a single-centre observational study. N Z Med J. 2020; 133: 16-22 PubMed Google Scholar , 2 Bangalore S Barsness GW Dangas GD Kern MJ Rao SV Shore-Lesserson L Tamis-Holland JE Evidence-based practices in the Cardiac Catheterization Laboratory: a scientific statement from the American Heart Association. Circulation. 2021; 144: e107-e119 Crossref PubMed Scopus (11) Google Scholar , 3 Brady MC Kinn S Stuart P Ness V. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev. 2003; 4CD004423 Google Scholar , 4 Hamid T Aleem Q Yeecheng Lau Singh R McDonald J Macdonald JE Sastry S Arya S Bainbridge A Mudawi T Balachandran K Pre-procedural fasting for coronary interventions: is it time to change practice?. Heart. 2014; 100: 658-661 Crossref PubMed Scopus (18) Google Scholar , 5 Mishra A Singh M Kane M Acker W Kaluski E Sattur S Sethi A Arora S Sporn D Strict versus no fasting prior to cardiac catheterization: a prospective evaluation of safety and clinical outcomes. Eur Heart J. 2019; 40 (ehz745.0983) Crossref Google Scholar , 6 Søreide E Eriksson LI Hirlekar G Eriksson H Henneberg SW Sandin R Raeder J (Task Force on Scandinavian Pre-operative Fasting Guidelines, Clinical Practice Committee Scandinavian Society of Anaesthesiology and Intensive Care Medicine). Pre-operative fasting guidelines: an update. Acta Anaesthesiol Scand. 2005; 49: 1041-1047 Crossref PubMed Scopus (210) Google Scholar In 1 particular study dubbed “CHOW NOW”, the lead investigator Abhishek Mishra, MD, and the research team concluded that within a group of 599 patients split into fasting and nonfasting groups before cardiac catheterization, there was no greater risk associated with not fasting before the procedure. In fact, Mishra also deducted evidence to suggest that not requiring patients to fast before cardiac catheterization increased patient satisfaction, lowered the duration of hospital stay, and reduced the cost of hospitalization per patient (1, SCAI News Release, Kalvaitis). With this present study, the researchers aimed to provide further evidence of the advantage of abolishing NPO standard practice before cardiac catheterization procedures to ensure a more modernized standard of care, with special attention directed to the comfortability of the patient.