Non-fasting strategy safe and effective for minimally invasive cardiac surgeries

Germany: For cardiac implantable electronic device ( CIED) procedures, a non-fasting strategy is beneficial to a fasting one in regards to patient's well-being and safety, state trial results published in the Europace.

Cardiac implantable electronic devices are used to correct abnormal heart rhythms. They have proven to be an invaluable tool in the practice of cardiology and their implantation rates continue to rise. The use of Minimal invasive cardiac surgeries for placement of such implants is increasing due to less bleeding, less trauma, fewer infections and a quicker recovery associated with them. Fasting before such surgeries helps prevent major complications, but there is no evidence to suggest that a shortened fluid fast results in an increased risk of aspiration, regurgitation or related morbidity compared with the standard 'nil by mouth from midnight' fasting policy. Data on the safety and efficacy of a non-fasting strategy in patients undergoing cardiac implantable electronic device (CIED) procedures are lacking.

Kerstin Bode, University of Leipzig, Germany conducted a randomized, single-blinded clinical trial to assess a non-fasting strategy compared with a fasting strategy regarding patient well-being and safety in CIED procedures.

Researchers enrolled 201 patients (non-fasting = 100, fasting = 101) with a mean age of 72.0 ± 11.6 years for the study. Patients were assigned to a non-fasting strategy (solids/fluids allowed up to 1 h) or a fasting strategy (at least 6 h no solids and 2 h no fluids) before the procedure and analysed on an intention-to-treat basis. The co-primary outcomes were set as patients' well-being scores (based on the numeric rating scale, 0–10) and incidence of intra-procedural food-related adverse events, including vomiting, perioperative pulmonary aspiration, and emergency intubation. Renal, haematological, and metabolic blood parameters and 30-day follow-up data were also gathered.

Key findings of the study,

• The summed pre-procedural patients' well-being score was significantly lower in the non-fasting group[ P = 0.029], which was mainly driven by significantly lower scores for hunger and tiredness in the non-fasting group

• There was no report of intra-procedural food-related adverse events.

• Relevant blood parameters and 30-day follow-up did not show significant differences.

The authors conclude that a non-fasting protocol is non-inferior to a fasting protocol (current practice) concerning safety and patient well-being, in those undergoing cardiac device implantation procedures.

Future large-scale trials are needed to ensure maximal patients' comfort and safety and to facilitate and maximize patient flow, the authors wrote.

Kerstin Bode, Matthias Gerhards, Michael Doering, Johannes Lucas, et al. A randomized trial of non-fasting vs. fasting for cardiac implantable electronic device procedures (Fast-CIED Study), EP Europace, 2022;, euac081, https://doi.org/10.1093/europace/euac081