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No fasting led to better health outcomes and patient satisfaction than fasting in a population of patients undergoing cardiac catheterization procedures, inciting the debate on whether fasting should be maintained before elective procedures requiring general/regional anesthesia or procedural sedation and analgesia.
The pragmatic SCOFF trial randomly assigned 716 participants scheduled for cardiac catheterization procedures 1:1 to fasting or no fasting before their procedure. Participants were stratified for procedure site and procedure type (i.e. coronary or device intervention). In the fasting arm, participants fasted solid foods for 6 hours and clear liquids for 2 hours. The primary endpoint was a composite of aspiration pneumonia, hypotension, hyperglycemia, and hypoglycemia. David Ferreira, MD, John Hunter Hospital, Australia, presented the results1.
With primary endpoint event rates of 19.1% in the fasting arm and 12.0% in the no-fasting arm, non-inferiority of no fasting to fasting was met. “No fasting was even superior to fasting,” added Dr. Ferreira. The effect appeared to be spread across the various components of the primary outcome, except for aspiration pneumonia, of which no cases were reported in either arm. Patient Satisfaction Scores were also in favor of the no fasting arm (mean 11 vs 15; Bayes factor >100). “However, performance bias is likely to have influenced the outcomes of this measure,” commented Dr. Ferreira.
“No fasting was non-inferior and superior to fasting before coronary catheterization and cardiac implantable device-related procedures for the primary composite outcome of aspiration pneumonia, hypotension, hyperglycemia, and hypoglycemia,” concluded Dr. Ferreira.
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