LB-4 | Cardiac Catheterization with Liberal Oral Intake: The CALORI trial

Routine pre-procedural fasting before cardiac catheterization remains standard of care, despite a lack of robust evidence to support this practice. We investigated the impact of a liberal non-fasting strategy versus standardized nil per os (NPO) regimen prior to cardiac catheterization. Adult inpatients undergoing elective or urgent cardiac catheterization were randomized (1:1 ratio), to either NPO past midnight or ad libitum intake of liquids and solids (without dietary constraints) immediately prior to procedure. Only patients at high risk of aspiration or undergoing complex interventions were excluded. The primary endpoint was pre-procedural patient-reported satisfaction scores (scaled 0-5, 0 signifying absence of variable and 5 the most extreme form), for variables including hunger, fatigue, anxiety, and nausea. A composite summed well-being score combined hunger and fatigue. Other endpoints were post-procedural satisfaction and peri-procedural adverse events including emesis, aspiration, or intubation. A total of 198 patients were included for final analysis. There were no differences in baseline characteristics (65% male, and 42% Black). Time from most recent oral intake (liquid or solid) to procedure start averaged 148 minutes for the non-fasting and 970 minutes for the NPO strategy (p<0.001). The composite pre-procedural well-being score was significantly better in the non-fasting arm (2.4 ± 2.4 non-fasting vs. 6.0 ± 2.5 NPO, p<0.001), as were the individual components of hunger (0.9 ± 1.5 vs. 3.7 ± 1.5, p<0.001), fatigue (1.5 ± 1.6 vs. 2.3 ± 1.8, p<0.001), and nausea (0.1 ± 0.5 vs. 0.5 ±1.2, p=0.006). There were no significant differences in adverse events between the groups. Post-procedural satisfaction scores were significantly better in the non-fasting versus NPO group (0.3 ± 0.7 vs. 1.0 ± 1.3, p<0.001). A liberal non-fasting strategy prior to cardiac catheterization significantly improves patient well-being and satisfaction without compromising safety. Few studies have prospectively explored this strategy in such a diverse patient population, and with such liberal non-fasting allowances, making it the most comprehensive and generalizable study on this topic to date.