New Best Practice Protocol “Planning for Anaphylaxis in the Catheterization Laboratory"

Two white puzzle pieces, one stating "best" and the other "practices" in blue, are connected on a medium blue background.

Severe contrast media reactions are uncommon but can be fatal if not promptly treated. Prior history of contrast reaction, especially of anaphylaxis, is the strongest risk factor for anaphylaxis. However, anaphylactic shock has been reported in patients with no known history of contrast media reactions and teams should consider anaphylaxis as a diagnosis in all patients with unexplained acute hemodynamic or respiratory distress after contrast media exposure. Patients with milder reactions can progress to more severe reactions and the catheterization laboratory and the recovery team should be ready to respond accordingly.

The new PCI Best Practice Protocol (BPP), “Planning for Anaphylaxis in the Catheterization Laboratory,” reviews choosing contrast for patients with prior anaphylaxis with and without results from prior allergy testing. It includes a chart adapted from the 2021 American College of Radiology Manual on Contrast Media which outlines classification of severity and management of immediate hypersensitivity reactions, and steps to take when patients are not responsive to epinephrine. The BPP also includes a pre-procedure checklist and guidance on team member roles in the case of an allergic reaction. Challenges to safe and effective care are also reviewed. You will find the complete BPP under “Best Practices” on’s “Quality Improvement” page.