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Quality and Safety

The effect of contrast material temperature on allergic reaction and extravasation rates: a meta-analysis of 307,329 injections

Saturday, May 6, 2023

    First Author(s)

  • MN

    Mohamad Nawras, BS

    Medical Student
    University of Toledo College of Medicine and Life Sciences, United States

    • Co-Author(s)

  • ZA

    Zakaria Alyousif, PhD, RRT

    Assistant Professor
    University of Toledo College of Health and Human Services, United States

  • AB

    Azizullah Beran, MD

    Gastroenterology Fellow
    Indiana University School of Medicine, Indiana, United States

  • HE

    Haitham Elsamaloty, MD

    Professor and Chair, Radiology Service Chief
    University of Toledo Department of Radiology, United States

Purpose: The effect of contrast material (CM) temperature on injection pressures and viscosity has been well established. However, the effect of extrinsic warming of CM on allergic reactions and extravasations remains unclear. The purpose of this study is to compare the rates of allergic reactions and extravasations between warmed CM to room temperature CM.

Methods/Materials: We performed a comprehensive literature search using PubMed, Embase, and Web of Science databases from inception to 12/26/2022, for all studies that assess the impact of warmed CM on clinical adverse events. The primary outcomes of our study were allergic reaction and extravasation rates. Secondary outcomes included physiological reaction rates and patient pain levels. Pooled odds ratio (OR) and corresponding 95% confidence intervals (CIs) were calculated using the random-effects model. A P-value < 0.05 was considered statistically significant. Heterogeneity was assessed using the Higgins I2 index (I2 values >50% implied the presence of significant heterogeneity).

Results: A total of five studies, including 307,329 CM injections (86,676 at room temperature and 220,653 warmed to 37C), were included in the analysis. The warmed CM group was associated with a significantly lower allergic reaction rate (OR:0.64; 95% CI:0.54-0.75; P< 0.00001) and there was no significant difference in extravasation rate between warmed and room temperature CM (OR:0.85; 95% CI: 0.58-1.25; P=0.40).

Conclusions: Our meta-analysis demonstrated that the use of warmed CM is associated with a significantly lower allergic reaction rate compared to room temperature CM (0.16% vs 0.27% respectively). However, there was no significant difference in extravasation rates between the two (0.29% vs 0.34% respectively). Therefore, our study supports the use of warmed CM in patients to reduce the rate of allergic reactions. Further large-scale randomized controlled trials are necessary to validate our findings.