Abstract
Background
Recent trials suggest that liberalizing oral intake prior to cardiac catheterization procedures improves patient satisfaction and is as safe as the traditional practice of "nothing by mouth." We aimed to compare the outcomes of fasting and nonfasting protocols before such procedures.
Methods
We searched PubMed and Cochrane Library until May 1, 2025, for clinical trials comparing fasting and nonfasting protocols for a variety of cardiac catheterization procedures. Outcomes of interest were all-cause mortality, aspiration, hypoglycemia, hyperglycemia, nausea/vomiting, contrast-induced nephropathy, and hypotension. Risk ratios (RR) with 95% CI were calculated using the inverse variance method, and quality was assessed using the Cochrane Risk of Bias 2.0 tool.
Results
We included 9 trials comparing fasting and nonfasting protocols, with a total sample of 3646 patients. We found no significant differences between the 2 groups for mortality (RR, 1.36; 95% CI, 0.55-3.36; I2 = 0%, χ2P = .78), aspiration (RR, 2.14; 95% CI, 0.28-16.53; I2 = 0; χ2P = .44), nausea/vomiting (RR, 0%; 95% CI, 0.62-1.53; I2 = 0%; χ2P = .74), or other outcomes. Patient satisfaction was greater in the nonfasting group in most trials, although heterogenous reporting precluded quantitative synthesis. Eight of the included studies had low risk of bias or some concerns.
Conclusions
We found that the nonfasting group had similar risk of complications as the fasting group, lending support to liberalizing oral intake prior to these procedures. Our findings provide impetus for standardized, evidence-based protocols in cardiac catheterization.
Keywords: aspiration, nothing by mouth, percutaneous coronary intervention, vomiting
Introduction
Patients undergoing cardiac catheterization procedures are traditionally instructed to maintain 'nothing by mouth' status before the procedure. This practice was extrapolated from early 20th century data that reported a high incidence of aspiration in obstetric patients receiving general anesthesia.1 Fasting was presumed to reduce gastric volume and acidity, thereby reducing the chances of vomiting and aspiration. Subsequent studies have challenged the physiologic basis for this practice by showing that fasting duration did not correlate with residual gastric volume or pH, nor did it affect postprocedural outcomes.2 Prolonged fasting may also predispose patients to dehydration, hypotension, and acute kidney injury, while causing significant discomfort.3 This has brought the need for preprocedural fasting before cardiac catheterization into question.
Recent clinical trials have shown liberalized fasting protocols before cardiac catheterization procedures to be just as safe as "nothing by mouth" protocols, while also improving patient satisfaction.4, 5, 6 However, guidelines remain ambiguous, leaving the choice of fasting protocol to the proceduralist or to hospital protocols.7,8 We aimed to conduct an updated meta-analysis of randomized controlled trials comparing the outcomes of fasting and nonfasting protocols before cardiac catheterization.
Materials and methods
We conducted this systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.9 Ethical clearance was not required as this is a meta-analysis of publicly available data.
Literature search and study selection
We performed a literature search of PubMed and Cochrane Library until May 1, 2025, to retrieve clinical trials comparing fasting and nonfasting protocols before cardiac catheterization procedures (Supplemental Methods). Additional articles were identified using citation tracking.
We included all clinical trials comparing fasting and non-fasting protocols for cardiac catheterization procedures, including coronary angiography, percutaneous coronary intervention, structural heart procedures, and catheter ablation for arrhythmias. We did not impose any restriction on language, sample size, or follow-up duration. We excluded observational studies, editorials, review articles, and study protocols.
Two investigators (V.B. and I.G.) independently screened all articles based on titles and abstracts, then conducted a full-text review. A third, senior investigator resolved all conflicts (A.Ku. or A.Ka.).
Data abstraction and quality assessment
From each included study, we extracted data on participant baseline characteristics, procedural details, event counts and sample sizes for all outcomes of interest, and follow-up duration. All outcomes were recorded until the longest available follow-up. Where specified, intention-to-treat data were extracted.
We used the Cochrane Risk of Bias 2.0 tool to assess the quality of each included study.10 Judgments were made to assess bias across 5 domains: (1) randomization process, (2) deviations from intended interventions, (3) missing outcome data, (4) measurement of the outcome, and (5) selection of the reported result. Each domain, along with the overall risk of bias, was rated as "low," "some," or "high" risk. This was carried out independently by V.B. and I.G., with disagreements resolved by A.Ku. or A.Ka.
Outcome measures
The outcomes of interest were all-cause mortality, aspiration, hypoglycemia, hyperglycemia, nausea/vomiting, contrast-induced nephropathy (CIN), hypotension, and patient satisfaction. Where specified, we extracted data on preprocedural patient satisfaction.
Data synthesis and analysis
We calculated risk ratios (RR) with 95% CI using the inverse variance method. For interstudy variance, we used the Paule-Mandel estimate for τ2. We also performed sensitivity analyses using the restricted maximum-likelihood estimator for τ2. The Q-profile method was used to derive CI of τ2 and τ. A continuity correction of 0.5 was applied to studies with zero cell frequencies. Heterogeneity was quantified with the I2 index, with 50% considered significant.
Publication bias was assessed using visual inspection of counter-enhanced funnel plots for all outcomes. A 2-sided P value < .05 was considered statistically significant. All analyses were carried out using R version 4.0.3.
Results
Characteristics of included studies
From an initial search that identified 1126 studies, we finally included 9 trials4, 5, 6,11, 12, 13, 14, 15, 16 (Figure 1). Altogether, these compared 1804 and 1842 patients in the non-fasting and fasting groups, respectively.
Figure 1.
PRISMA flowchart, showing search strategy, screening, and assessment for eligibility, leading to inclusion of 9 clinical trials. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Baseline and procedural characteristics
Most participants (>60%) were men, with average age >60 years in both fasting and nonfasting groups. In studies that reported it, hypertension was common (>60%), with varying proportions of diabetes mellitus (Table 1).4, 5, 6,11, 12, 13, 14, 15
Table 1.
Baseline and procedural characteristics of patients in the included studies
| Study, year |
Li et al,14 2017 |
CHOW NOW13, 2020 |
Fast-CIED,6 2022 |
Atkinson et al16, 2023 |
TONIC, 2024 |
SCOFF,4 2024 |
CALORI,15 2024 |
CORO-NF,11 2024 |
Woods et al,12 2024 |
|||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Country | Singapore | USA | Germany | USA | France | Australia | USA | Italy | USA | |||||||||
| Characteristic | I | C | I | C | I | C | I | C | I | C | I | C | I | C | I | C | I | C |
| Number | 249 | 266 | 293 | 306 | 100 | 101 | 90 | 91 | 376 | 379 | 358 | 358 | 104 | 94 | 150 | 150 | 100 | 97 |
| Age, y | 62.3 | 62.5 | – | – | 71.6 | 72.5 | 68.1 | 68.9 | 68 | 67 | 69 | 70 | 60.5 | 61.5 | 69 | 69 | 62.7 | |
| Male sex | 73.9 | 79.7 | – | – | 67.0 | 66.3 | 58 | 63 | 75 | 76 | 65.9 | 64.5 | 65.4 | 63.8 | 66.7 | 74.6 | 62.4 | |
| BMI, kg/m2 | – | – | – | – | 28.4 | 27.9 | – | – | 27 | 27 | 29.6 | 29.6 | 29.4 | 28.8 | – | – | – | – |
| HTN | 65.5 | 68.8 | – | – | 72.0 | 77.2 | – | – | 72 | 72 | 69.6 | 69.8 | 65.4 | 79.8 | 66.7 | 74.6 | – | – |
| HF | – | – | – | – | – | – | 37.8 | 51.6 | 15a | 18a | 14.3 | 12.0 | – | – | – | – | – | – |
| DM | 50.6 | 41.7 | – | – | – | – | 23.3 | 22.0 | 30 | 28 | 26.5 | 27.1 | 49.1 | 50.0 | 34 | 35.3 | – | – |
| CKD | – | – | – | – | – | – | 17.8 | 16.5 | 20b | 16b | 19.5 | 22.0 | 53.8 | 55.3 | – | – | – | – |
| DLP | – | – | – | – | – | – | – | – | 58 | 59 | 47.8 | 51.1 | – | – | 56.7 | 56 | – | – |
| Smoking | – | – | – | – | – | – | 63.3 | 55.0 | 51 | 48 | 60.8 | 57.7 | – | – | – | – | – | – |
| Past MI | – | – | – | – | 28.0 | 27.7 | – | – | – | – | 25 | 20.1 | – | – | – | – | – | – |
| Past PCI | – | – | – | – | – | – | 22.2 | 15.4 | 30 | 28 | 20.9 | 19.0 | – | – | – | – | – | – |
| Past CABG | – | – | – | – | – | – | 10.0 | 9.9 | 6 | 5 | 8.4 | 6.4 | – | – | – | – | – | – |
| GERD | – | – | – | – | 1.0 | 4.0 | 25.6 | 27.5 | – | – | – | – | – | – | – | – | – | – |
| Procedure | Elective angiography ± PCI | Cardiac catheterization | Elective CIED procedures | Elective TAVR, arrhythmia ablation | Elective/semi-urgent angiography ± PCI | Elective angiography, PCI, CIED | Elective/urgent cardiac catheterization | Elective coronary angiography ± PCI | Elective cardiac catheterization | |||||||||
| Anesthesia | Local anesthesia ± sedation | – | Local anesthesia ± sedation | General anesthesia with ETT/deep sedation | Local anesthesia ± sedation | Sedation | Local anesthesia ± sedation | Local anesthesia ± sedation | Sedation | |||||||||
| Fasting timec, min | – | – | – | – | 312 | 758 | 210 | 570 | 180 | 900 | 144 | 420 | 148 | 970 | 230 | 821 | – | – |
Values are percentages unless otherwise specified.
BMI, body mass index; C, control (fasting protocol); CAD, coronary artery disease; CABG, coronary artery bypass graft; CIED, cardiac implantable electronic device; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; DLP, dyslipidemia; DM, diabetes mellitus; ETT, endotracheal tube; GERD, gastroesophageal reflux disease; HF, heart failure; HTN, hypertension; I, intervention (no-fasting protocol); MI, myocardial infarction; PCI, percutaneous intervention; TAVR, transcatheter aortic valve replacement.
HF with left ventricular ejection fraction <45%.
Creatinine clearance <60 mL/min.
Since last oral intake.
Six studies focused on cardiac catheterization,5,11, 12, 13, 14, 15 one on cardiac implantable electronic device implantation,4 one on both catheterization and cardiac implantable electronic devices,6 and one on transcatheter aortic valve replacement and catheter ablation for arrhythmias16 (Table 1; Supplemental Table S1).
All but one study involved local anesthesia with sedation as required. Fasting protocols for both groups varied across studies, with nothing by mouth enforced as early as midnight for the fasting group. Similarly, for the nonfasting group, protocols ranged from no restriction on intake to fasting from 2 hours before the procedure (Supplemental Table S2). As expected, the fasting group had significantly longer mean durations since last oral intake, as long as 970 minutes, compared with a maximum mean duration of 312 minutes for the nonfasting group (Table 1).
Outcomes
All-cause mortality: Five studies reported mortality. Risk of all-cause mortality was similar in both groups (RR, 1.36; 95% CI, 0.55-3.36; I2 = 0%, χ2 P = .78) (Figure 2A).
Figure 2.
Forest plot of random-effects analysis comparing outcomes in patients following nonfasting protocols (intervention) with those in patients following fasting protocols (control). Outcomes: (A) all-cause mortality, (B) aspiration, (C) hypoglycemia, (D) hyperglycemia, (E) nausea/vomiting, (F) contrast-induced nephropathy, (G) hypotension. IV, inverse variance.
Aspiration: Seven studies reported aspiration. Risk of aspiration was similar in both groups (RR, 2.14; 95% CI, 0.28-16.53; I2 = 0%, χ2 P = .44) (Figure 2B).
Hypoglycemia: Five studies reported hypoglycemia. Risk of hypoglycemia was similar in both groups (RR, 0.79; 95% CI, 0.47-1.34; I2 = 0%; χ2 P = .39) (Figure 2C).
Hyperglycemia: Three studies reported hyperglycemia. Risk of hyperglycemia was similar in both groups (RR, 0.69; 95% CI, 0.43-1.11; I2 = 0; χ2 P = .35) (Figure 2D).
Nausea/vomiting: Seven studies reported nausea/vomiting. Risk of nausea/vomiting was similar in both groups (RR, 0.97; 95% CI, 0.62-1.53; I2 = 0%; χ2 P = .74) (Figure 2E).
CIN: Three studies reported CIN. Risk of CIN was similar in both groups (RR, 1.87; 95% CI, 0.93-3.77; I2 = 0%; χ2 P = .75) (Figure 2F).
Hypotension: Three studies reported hypotension. Risk of hypotension was similar in both groups (RR, 0.64; 95% CI, 0.39-1.05; I2 = 22%; χ2 P = .28) (Figure 2G).
On fixed-effect sensitivity analyses, risk of hypotension was lower in the nonfasting group (RR, 0.64; 95% CI, 0.43-0.94; I2 = 22%; χ2 P = .28) (Figure 3G). Risk of all-cause mortality, aspiration, hypoglycemia, hyperglycemia, nausea/vomiting, and CIN were similar between the 2 groups (Figure 3A-F).
Figure 3.
Forest plot of fixed-effects sensitivityanalysis comparing outcomes in patients following nonfasting protocols (intervention) with those in patients following fasting protocols (control). Outcomes: (A) all-cause mortality, (B) aspiration, (C) hypoglycemia, (D) hyperglycemia, (E) nausea/ vomiting, (F) contrast-induced nephropathy, (G) hypotension. IV, inverse variance.
Patient satisfaction: Five studies reported preprocedural patient satisfaction/well-being. Four of these reported greater satisfaction in the nonfasting group. However, significant heterogeneity in reporting, as well as measurement techniques, precluded quantitative pooling.
Publication bias
Based on visual inspection of counter-enhanced funnel plots, there were suggestions of potential publication bias, although they were not significant (Figure 4; Supplemental Figure S1).
Figure 4.
Counter-enhanced funnel plot for all-cause mortality.
Risk of bias
Five studies had low risk of bias. Three studies had some concerns, primarily stemming from lack of publicly available protocols or trial registrations indicating prespecified outcomes or analysis plans. One study was deemed to have a high risk of bias due to the absence of true randomization in patient allocation (Figure 5).
Figure 5.
Quality assessment utilizing Cochrane Risk of Bias 2.0 for all included clinical trials. Generated using robvis tool.
Discussion
In our meta-analysis of clinical trials comparing fasting with non-fasting protocols for a variety of cardiac catheterization-based procedures, we found no difference in key outcomes, including mortality, aspiration, nausea/vomiting, or hypotension. On sensitivity analyses, the nonfasting protocol had lower risk of hypotension. Furthermore, most studies reported greater patient satisfaction in the nonfasting cohort (Central Illustration). These findings confirm those of prior randomized controlled trials and meta-analyses, and provide further impetus for liberalizing fasting protocols in cardiac catheterization.
Central Illustration.
Meta-analysis of 9 clinical trials comparing fasting and nonfasting protocols before cardiac catheterization procedures. No difference between groups in risk of complications between groups, but greater patient satisfaction in the nonfasting group.
The 'nothing by mouth' strategy for cardiac catheterization lacks data specific to interventional cardiac procedures. Protocols were derived from surgical data, rooted in historic concerns for vomiting and aspiration, as well as historically higher procedural complications requiring endotracheal intubation.1,7,8 Today, the overall incidence of aspiration during procedures is miniscule, with reported rates as low as 0.01%.15,17 Furthermore, for cardiac catheterization, sedation is the contemporary practice, having lower risk of aspiration than general anesthesia. Additionally, modern nonosmolar/hypo-osmolar contrast agents have significantly reduced risk of vomiting than historical hyperosmolar agents.7 Finally, the risk of conversion of catheterization, be it emergent or elective, to open surgery, is minimal.7,18
Data supporting liberalizing fasting protocols have emerged across specialties, with the broad takeaway being that food intake has no relation to aspiration or vomiting.19,20 To this end, the most recent American Society of Anesthesiologists guidelines have also recommended shortening fasting protocols for healthy patients undergoing elective procedures.21 Taken together, it remains prudent to reassess the practice of 'nothing by mouth'. Professional cardiology societies acknowledge that evidence is weak, but, possibly due to inertia, prolonged preprocedural fasting times remain in use.7,8 Further, actual fasting durations often exceed the mandated duration, stemming from a combination of hospital meal schedules and procedure delays.22
In most included trials in our analysis, liberal fasting protocols were associated with greater patient satisfaction. One study even reported that as fasting duration increased, patient satisfaction decreased in a linear manner.15 Most importantly, there was no difference in key outcomes of aspiration and nausea/vomiting. Liberal fasting protocols may have workflow-related advantages as well. They could prevent delays or cancellations resulting from deviations from strict 'nothing by mouth' protocols, thus enabling the accommodation of more patients.
Our meta-analysis provides a comprehensive, updated evaluation of available data from a variety of cardiac procedures. However, it is not without limitations, and its findings require cautious interpretation. First, because it is a study-level meta-analysis, we could not account for patient-level heterogeneity. Second, each study used different nonfasting protocols and variable or unclear outcome definitions. Third, several outcomes were reported only in a minority of studies, and reports of rare or no events reduced the precision of effect estimates, as reflected by wide CI for outcomes of mortality and aspiration. Fourth, while comprehensive and up to date, we did include abstracts, which provide limited methodological detail. Fifth, owing to their inherent design, most trials were single-blind, which, though unlikely, may have introduced bias. Although not significant, funnel plots could not rule out potential publication bias. Finally, we could not evaluate outcomes in certain high risk populations, including hemodynamically unstable patients or those with sleep apnea, gastric motility disorders, or uncontrolled diabetes, to whom the observed benefits of liberalized fasting may not extend.
In conclusion, we found that patients subjected to liberalized fasting protocols before cardiac catheterization had similar risk of complications, along with greater satisfaction, than patients subjected to stricter fasting. Given the rarity of some outcomes in our analysis, limiting statistical power, additional larger trials designed to establish noninferiority may clarify the safety of nonfasting protocols with greater precision. Additionally, further trials are warranted to extend the validity of these findings in patients with specific conditions increasing risk of vomiting or aspiration, such as gastroparesis or diabetes mellitus. Consensus regarding this practice from clinical societies is the need of the hour.
Declaration of competing interest
Ankur Kalra is the chief executive officer and creative director of makeadent.org, a 501(c)3 registered nonprofit organization. All other authors reported no financial interests.
Acknowledgments
Funding sources
This work was funded by makeadent.org Ram and Sanjita Kalra Aavishqaar Fund. There was no role of the funder in the design and conduct of the study, collection, analysis, or interpretation of the data, or preparation, review, or approval of the manuscript.
Ethics statement and patient consent
This article does not report on patients or individual patient data. Ethical approval and patient consent were not required.
Footnotes
To access the supplementary material accompanying this article, visit the online version of the Journal of the Society for Cardiovascular Angiography & Interventions at 10.1016/j.jscai.2025.104161.
Supplementary Material
References
- 1.Mendelson C.L. The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol. 1946;52:191–205. doi: 10.1016/s0002-9378(16)39829-5. [DOI] [PubMed] [Google Scholar]
- 2.Brady M., Kinn S., Stuart P. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev. 2003;(4):CD004423. doi: 10.1002/14651858.CD004423. [DOI] [PubMed] [Google Scholar]
- 3.Hamid T., Aleem Q., Lau Y., et al. Pre-procedural fasting for coronary interventions: is it time to change practice? Heart. 2014;100(8):658–661. doi: 10.1136/heartjnl-2013-305289. [DOI] [PubMed] [Google Scholar]
- 4.Ferreira D., Hardy J., Meere W., et al. Fasting vs. no fasting prior to catheterization laboratory procedures: the SCOFF trial. Eur Heart J. 2024;45(47):4990–4998. doi: 10.1093/eurheartj/ehae573. [DOI] [PubMed] [Google Scholar]
- 5.Boukantar M., Chiaroni P.M., Gallet R., et al. A randomized controlled trial of nonfasting vs fasting before interventional coronary procedures: the TONIC trial. JACC Cardiovasc Interv. 2024;17(10):1200–1210. doi: 10.1016/j.jcin.2024.03.033. [DOI] [PubMed] [Google Scholar]
- 6.Bode K., Gerhards M., Doering M., et al. A randomized trial of non-fasting vs. fasting for cardiac implantable electronic device procedures (Fast-CIED Study) Europace. 2022;24(10):1617–1626. doi: 10.1093/europace/euac081. [DOI] [PubMed] [Google Scholar]
- 7.Bangalore S., Barsness G.W., Dangas G.D., et al. Evidence-based practices in the cardiac catheterization laboratory: a scientific statement from the American Heart Association. Circulation. 2021;144(5):e107–e119. doi: 10.1161/CIR.0000000000000996. [DOI] [PubMed] [Google Scholar]
- 8.Naidu S.S., Abbott J.D., Bagai J., et al. SCAI expert consensus update on best practices in the cardiac catheterization laboratory: This statement was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), and the Heart Rhythm Society (HRS) in April 2021. Catheter Cardiovasc Interv. 2021;98(2):255–276. doi: 10.1002/ccd.29744. [DOI] [PubMed] [Google Scholar]
- 9.Page M.J., McKenzie J.E., Bossuyt P.M., et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372 doi: 10.1136/bmj.n71. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Sterne J.A.C., Savović J., Page M.J., et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366 doi: 10.1136/bmj.l4898. [DOI] [PubMed] [Google Scholar]
- 11.Tamborrino P.P., Papi L., Michelotti L., et al. Do we need fasting prior to coronary angiography? The CORO-NF randomized pragmatic study. Am J Med. 2024;137(7):666–672. doi: 10.1016/j.amjmed.2024.01.024. [DOI] [PubMed] [Google Scholar]
- 12.Woods C., Wood M., Boylan A., Flanagan M.E., Powers J. Fasting versus a heart-healthy diet before cardiac catheterization: a randomized controlled trial. Am J Crit Care. 2024;33(1):29–33. doi: 10.4037/ajcc2024115. [DOI] [PubMed] [Google Scholar]
- 13.Mishra A., Singh M., Lodhi A., Kaluski E., Sattur S., Sporn D.P. SCAI 2020 Virtual Scientific Sessions: Virtual Conference; May 14-16, 2020. 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.https://scai.confex.com/scai/2020/webprogramarchives/Paper11758.html [Google Scholar]
- 14.Li Y., Latt T.Z., Tan C., Ho H.H., Ong P.J.L., Watson T.J. TCTAP A-105 Routine cardiac catheterization is safe in non-fasted patients. J Am Coll Cardiol. 2017;69(16 suppl):S58–S59. doi: 10.1016/J.JACC.2017.03.146. [DOI] [Google Scholar]
- 15.Mitchell B.K., Tomdio A., Pir M.S., et al. A randomized trial of cardiac catheterization with fasting versus liberal oral intake: the CALORI trial. J Soc Cardiovasc Angiogr Interv. 2024;3(12) doi: 10.1016/j.jscai.2024.102291. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Atkinson D.J., Romeiser J.L., Almasry I.O., Tannous H.J., Parikh P.B., Bennett-Guerrero E. Randomized controlled trial of liberal vs. standard fasting instructions in percutaneous cardiac procedures. Perioper Med (Lond) 2023;12(1):44. doi: 10.1186/s13741-023-00333-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Sun J., Wei G., Hu L., Liu C., Ding Z. Perioperative pulmonary aspiration and regurgitation without aspiration in adults: a retrospective observational study of 166,491 anesthesia records. Ann Palliat Med. 2021;10(4):4037–4046. doi: 10.21037/apm-20-2382. [DOI] [PubMed] [Google Scholar]
- 18.Seshadri N., Whitlow P.L., Acharya N., Houghtaling P., Blackstone E.H., Ellis S.G. Emergency coronary artery bypass surgery in the contemporary percutaneous coronary intervention era. Circulation. 2002;106(18):2346–2350. doi: 10.1161/01.cir.0000036595.92742.69. [DOI] [PubMed] [Google Scholar]
- 19.Kwon O.K., Oh C.W., Park H., et al. Is fasting necessary for elective cerebral angiography? AJNR Am J Neuroradiol. 2011;32(5):908–910. doi: 10.3174/ajnr.A2408. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Yap C.Y.L., Taylor D.M., Kong D.C.M., Knott J.C., Taylor S.E. Sedation for Acute Agitation in Emergency Department Patients: Targeting Adverse Events (SIESTA) Collaborative Study Group. Risk factors for sedation-related events during acute agitation management in the emergency department. Acad Emerg Med. 2019;26(10):1135–1143. doi: 10.1111/acem.13826. [DOI] [PubMed] [Google Scholar]
- 21.Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists task force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. Anesthesiology. 2017;126(3):376–393. doi: 10.1097/ALN.0000000000001452. [DOI] [PubMed] [Google Scholar]
- 22.Bacus S.B., 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(1510):16–22. [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.