Statement from the ACR Committee on Drugs and Contrast Media on the Intravenous Iodinated Contrast Media Shortage

Wang, Carolyn L.; Asch, Daniella; Cavallo, Joseph J.; Dillman, Jonathan R.; Ellis, James; Forbes-Amrhein, Monica; Gilligan, Leah A; Krishnan, Pranay; McDonald, Robert J.; McDonald, Jennifer S.; Murphy, Brian L.; Mervak, Benjamin M.; Newhouse, Jeffrey H.; Pahade, Jay; Sumkin, Alisa; Weinreb, Jeffrey C.; Weinstein, Stefanie

doi:10.1016/j.jacr.2022.05.006

Cited by 30 publications

(31 citation statements)

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“…Hence, angiographic outcomes, radiographic metrics and immediate complication rates were not adversely impacted with this strategy. Contrast conservation measures such as this are especially important in times of uncertainty to be able to continue to provide life-saving procedures such as MT 12 13. The overall contrast conservation per MT procedure was close to 85 mL from modifications to both pre-MT imaging (70 mL) and the MT procedure itself (15 mL).…”

Section: Discussionmentioning

confidence: 92%

Contrast conservation measures during the global iohexol contrast shortage crisis did not affect stroke thrombectomy outcomes

Almallouhi

Sattur

Lajthia

et al. 2022

J NeuroIntervent Surg

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BackgroundThe current global shortage in iohexol contrast material (Omnipaque) used in performing CT-based triage images and mechanical thrombectomy (MT) represents a challenge to the healthcare system. A study was undertaken to assess the safety and feasibility of implementing protocol-based changes in pre-MT and MT workflow at a comprehensive stroke center.MethodsA retrospective cohort study was undertaken of all patients with stroke who underwent MT during a 3-week period before implementing the contrast shortage protocol and for 3 weeks while implementing the protocol. The contrast shortage protocol included not performing perfusion images for MT selection and using diluted iohexol (50% contrast mixed with 50% heparinized saline) during the MT procedure. Procedural variables were compared between the two groups.ResultsA total of 27 patients underwent MT during the study period, 12 pre-contrast shortage and 15 post-contrast shortage. The average contrast volume used during the MT procedure was reduced from 83 mL to 68 mL after implementing the contrast shortage protocol (p=0.04). No difference was noted in the rate of successful reperfusion (11/15 vs 10/12), average time to recanalization (21 vs 23 min), average radiation dose (1143 vs 1117mGy) and time under fluoroscopy (20.7 vs 20.5 min) in the pre- and post-contrast shortage groups. A favorable discharge outcome was observed in 3/12 patients and 4/15 patients in the pre- and post-shortage periods, respectively (p=0.92).ConclusionsModifying stroke workflow to adapt to the current global shortage in iohexol is feasible. Using diluted iohexol (50% contrast mixed with 50% heparinized saline) did not affect MT outcomes.

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Section: Discussionmentioning

confidence: 92%

Contrast conservation measures during the global iohexol contrast shortage crisis did not affect stroke thrombectomy outcomes

Almallouhi

Sattur

Lajthia

et al. 2022

J NeuroIntervent Surg

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“…Our steps mirrored the strategic actions taken by multiple other institutions and are consistent with ACR recommendations with overarching goals of extending contrast supply run rate and reducing waste. [10,17] consumption [Figure 3]. Similarly, there was an increase in available contrast from GE in mid-June as the production at the Shanghai plant expanded.…”

Section: Overarching Strategy and Background Analysismentioning

confidence: 99%

Metrics-driven successful strategy by emergency and radiology driven task force to mitigate global CT contrast media shortage in a safety net hospital

Gopireddy

Virarkar

Vulasala

et al. 2023

JCIS

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Iodinated contrast media (ICM) shortages and secondary supply chain problems due to Coronavirus Disease lockdowns in China significantly impacted radiology operations nationwide. The lack of ICM necessitated operational workflow changes designed to ration contrast use, particularly in the hospital setting. In this manuscript, we share our strategic methods with advanced process/outcome metrics to monitor the effectiveness of our strategy under a coordinated multidisciplinary team effort. Alternate studies such as substituting magnetic resonance angiography for computed tomographic angiography for emergency department patients were studied to measure the suitability of these examinations for specific diagnoses. This article presents readers with a comprehensive crisis management strategy deployed at our institution, emphasizing various options with a limited ICM supply, and minimizing the impact on clinical care.

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“…Given increased clinical reliance on CT, which often includes the need for intravenous contrast, for the diagnosis and follow-up of a variety of conditions and its associated dramatic utilization growth over recent decades [ 2 ], disruptions in patient care have already occurred and are anticipated to continue. The ACR recently released recommendations to help mitigate that impact [ 3 ], and individual centers are beginning to share their institutional approaches and experience [ 4 , 5 ].…”

Section: Description Of the Problemmentioning

confidence: 99%

“…Emerging published iodinated contrast reduction guidelines and institutional implementation strategies [ 3 , 4 , 5 ] largely focus on efficiently and robustly identifying scenarios in which contrast use may be minimized or avoided by using alternative imaging modalities, contrast agents, or protocols that reduce or minimize waste resulting from individual doses. In implementing these strategies, radiology practices and departments may find their greatest mitigation impact focusing on the most frequently used CT services outlined herein, and particularly abdominal/pelvic and chest CT in the emergency department and hospital outpatient settings as well as brain and head/neck CTA in the emergency department and hospital inpatient settings.…”

Section: Outcomes and Limitationsmentioning

confidence: 99%

An Empiric Medicare Claims-Based Utilization Approach to Mitigating the Iodinated Contrast Shortage

Duszak

Hemingway

Christensen

et al. 2022

Journal of the American College of Radiology

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Statement from the ACR Committee on Drugs and Contrast Media on the Intravenous Iodinated Contrast Media Shortage

Cited by 30 publications

References 0 publications

Contrast conservation measures during the global iohexol contrast shortage crisis did not affect stroke thrombectomy outcomes

Contrast conservation measures during the global iohexol contrast shortage crisis did not affect stroke thrombectomy outcomes

Metrics-driven successful strategy by emergency and radiology driven task force to mitigate global CT contrast media shortage in a safety net hospital

An Empiric Medicare Claims-Based Utilization Approach to Mitigating the Iodinated Contrast Shortage

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