Iodinated contrast media shortage: Insights and guidance from two major public hospitals

Abstract

Global shortage of iodinated contrast medium (ICM) is the latest health care ripple-effect from the COVID-19 pandemic. Some public hospitals in Australia have less than a week's supply. Strategies are, therefore, urgently needed to conserve ICM for those diagnostic tests and interventions, which are time-critical, and without which patients would suffer death or significant morbidity. A plan is also required to continue providing best possible care to patients in the worst-case scenario of exhausted ICM supplies. This document, by representatives from two major public hospitals, will provide some guidance that is tailored to the Australian context.

Keywords: contrast dose reduction; contrast-enhanced CT; iodinated contrast media.

Fig. 1

Approach to determining how long ICM inventory will meet critical demand and calculating surplus. [Colour figure can be viewed at wileyonlinelibrary.com]

Fig. 2

Most frequently performed CECTs at Monash Health in the period from 1/7/22 to 13/5/22. [Colour figure can be viewed at wileyonlinelibrary.com]

Fig. 3

Growth in ED CT numbers. (a) Emergency department‐referred frequent‐flyer CECTs performed per year. The dip in 2020/21 was related to reduced ED presentations during the COVID‐19 lockdowns. (b) Number of multimodal code stroke CTs (NECT brain, CTA brain and neck, and brain CTP) and ECR procedures performed per month. While ‘code stroke’ CTs have increased since the COVID‐19‐related dip in April 2020, ECR procedures have decreased. The primary purpose of ‘code stroke’ CT is to identify stroke patients with large‐vessel occlusions who may benefit from ECR. [Colour figure can be viewed at wileyonlinelibrary.com]

Fig. 4

Risk stratification and decision support pathway for suspected pulmonary embolus. [Colour figure can be viewed at wileyonlinelibrary.com]

Fig. 5

Reduction in ICM volume used for ED CECTs on the first weekday after the introduction of the following interventions: ED consultant‐level referrals to CECT, risk stratification for CTPA (including diversion to VQ scan for patients with normal CXR), non‐contrast CT for several abdominal indications and minor trauma, ED consultant or surgical registrar assessment prior to abdominal CECT and ICM dose reduction for ‘code stroke’ CT and CTPA. [Colour figure can be viewed at wileyonlinelibrary.com]