VIDEO: How the iodine contrast shortage is impacting interventional cath labs
Kirk Garratt, MD, MSc, MSCAI, medical director of the Center for Heart and Vascular Health, the John H. Ammon Chair of Cardiology at ChristianaCare, and a past president of the Society of Cardiovascular Angiography and Interventions (SCAI).
He discusses how the spring 2022 iodine imaging contrast shortage is affecting interventional cardiology and interventional radiology catheterization labs that rely on the agent to navigate catheters and devices inside vessels and to diagnosis patients. Reducing usage has been a primary strategy at some hospitals, including delaying elective procedures, finding alternative imaging and reserving contrast for acute cath lab cases that cannot be deferred.
"Delaying elective cases is not the worse idea in the world, but I am concerned because we are picking up people who are further along in their disease journey than we would have expected [due to COVID]," Garratt explained.
Garratt said his department is working with his hospital's pharmacy department to see if larger bolus packaging of contrast can be broken down in the pharmacy clean room into small, single use syringes to reduce wastage. Labs equipped with automated contrast media injectors can leverage these machines to reduce contrast.
His interventional cardiology department is also considering using MRI gadolinium contrast as al alternative is the shortage continues, even though gadolinium offers only about one-third the contrast opacity offered by iodine agents.
"The k-edge is a little different, so the images are not as good," Garratt said. He said gadolinium was looked at as a possible alternative in the cath lab 20 years ago and not adopted, but the shortage has resurrected the conversation.
Some angiography imaging system vendors offer roadmapping technology that allows a single contrast injection to create an image of the coronary tree that is then superimposed on live fluoro to help guide catheters without using contrast. Garratt said this technology might be looked at more seriously in light of the contrast shortage.
GE Healthcare, which supplies more than 50% of the iodine contrast in the U.S., faces a serious shortage of imaging agent because its primary manufacturing plant in Shanghai, China, was shut down for several weeks due to a local COVID-19 outbreak. GE said the factory is now at 50% capacity as of May 18, and it hopes to have supplies back to normal by July. However, there are fears an increase in COVID cases in China could result in additional factory shutdowns and a continued shortage over the summer.
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Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com