What You Need to Know: Navigating the Iodinated Contrast Media Shortage
The shutdown of a GE manufacturing facility in Shanghai, China, during a COVID-19 lockdown in April has led to a significant shortage of iodinated contrast media worldwide. While the GE facility has reopened and production is expected to be at full capacity by the week of June 6, the shortage and its related impacts are expected to continue into July.
The ACC, working closely with its Board of Governors (BOG), Member Sections, and MedAxiom, has put together resources to support clinicians, health systems, hospitals and other facilities as they manage through the crisis and mitigate impacts to patient care. A recent MedAxiom survey in response to the shortage found:
- 97% of programs surveyed are aware of a potential shortage of iodinated contrasty, with the majority using GE as their supplier.
- Nearly 60% of respondents say local supply chain manages their iodinated contrast inventory and/or ordering.
- More than 80% of programs have a local or system mechanism or committee structure that could rapidly respond if the contrast shortage becomes prolonged.
The impact of the shortage is highly variable based on individual hospitals, health systems and other facilities and their respective supplies, purchasing and supply chain processes, as well as other factors. Hospitals fully reliant on GE contrast media are the most impacted – or likely to be impacted – by the shortage.
Frontline feedback from ACC's BOG, Interventional Member Section and partner cardiovascular societies including the Society for Cardiovascular Angiography and Interventions (SCAI), suggests responses to the shortage have varied, with some facilities beginning to cancel or reschedule non-urgent contrast requiring cardiac procedures and imaging, while other bodies are still assessing all their options.
"The current contrast shortage has potentially far-reaching implications," says Wayne Batchelor, MD, FACC, chair of ACC's Interventional Section. "Hospitals and outpatient diagnostic centers should become intimately familiar with their supply chain while employing strategies to preserve contrast and avoid waste."
To date, several groups have issued informational guidance (see below) providing options for conserving supply and preserving patient access to care. Common themes across all the documents, as well as from on-the-ground feedback, are the need for hospitals and services lines to work together to assess and plan for short-term and potential long-term scenarios in ways that do not sacrifice the quality of care delivered. In addition, facilities and health systems should also consider the impacts of their individual decisions (i.e., bulk purchasing) on the broader U.S. patient population to ensure some level of equitable access. Strategies to manage the current contrast shortage and its clinical fallout center around:
- Conservation of available supply
- Prioritization based on clinical risk and acuity
- Identification of alternative non-contrast studies to answer a given clinical question
"We have an opportunity to come together to mitigate the impact of this shortage to our patients and communities," says Andrea Price, MS, RCIS, CPHQ, AACC, chair of ACC's CV Team Section. "By focusing on conserving contrast today, we will hopefully avoid the impact that may limit emergent or urgent care for our patients in the future."
- SCAI's contrast shortage "Tip of the Month" offers tips for assessing and extending supply as well as options for reducing contrast utilization during angiography and PCI and suggestions for what to do in severe shortage situations where little to no contrast media is available.
- The American College of Radiology's Committee on Drugs and Contrast Media's statement provides detailed recommendations on ways providers can address the emergency locally, including using alternative studies to answer the clinical question; looking for alternative versions and/or sources of contrast agents; minimizing individual doses administered to reduce waste; and more.
- The American Society of Health-System Pharmacists' (ASHP) Considerations for Imaging Contrast Shortage Management and Conservation document offers insights into conserving contrast, repackaging contrast, and administering repackaged contrast. Importantly, ASHP also encourages the reporting of any medication errors related to drug shortages to the Medication Error Reporting page on the Institute for Safe Medication Practices website.
Share Your Experiences on ACC's Member Hub
The ACC is committed to working with all stakeholders to provide a forum for sharing information and guidance until the crisis ends. A discussion forum has been set up on ACC's Member Hub to facilitate the sharing of information and best practices. Data collected into the relevant NCDR clinical registries will also provide insight into utilization and quality outcomes. Access the Member Hub discussion.
Keywords: Contrast Media, Hospital Rapid Response Team, COVID-19, Percutaneous Coronary Intervention, Hospitals, Health Services Accessibility, Quality of Health Care, Ambulatory Care, Angiography, Radiology, Pharmaceutical Preparations
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