title: Patient Comfort During Contrast Media Injection in Coronary Computed Tomographic Angiography Using Varying Contrast Media Concentrations and Flow Rates: Results From the EICAR Trial.
abstract: Pain sensation and extravasation are potential drawbacks of contrast media (CM) injection during computed tomographic angiography. The purpose was to evaluate safety and patient comfort of higher flow rates in different CM protocols during coronary computed tomographic angiography.
  
  
  
  Two hundred consecutive patients of a double-blind randomized controlled trial (NCT02462044) were analyzed. Patients were randomized to receive 94 mL of prewarmed iopromide 240 mg I/mL at 8.3 mL/s (group I), 75 mL of 300 mg I/mL at 6.7 mL/s (group II), or 61 mL of 370 mg I/mL at 5.4 mL/s (group III), respectively. Iodine delivery rate (2.0 g I/s) and total iodine load (22.5 g I) were kept identical. Outcome was defined as intravascular enhancement, patient comfort during injection, and injection safety, expressed as the occurrence of extravasation. Patients completed a questionnaire for comfort, pain, and stress during CM injection. Comfort was graded using a 5-point scale, 1 representing "very bad" and 5 "very well." Pain was graded using a 10-point scale, 0 representing "no pain" and 10 "severe pain." Stress was graded using a 5-point scale, 1 representing "no stress" and 5 "unsustainable stress."
  
  
  
  Mean enhancement levels within the coronary arteries were as follows: 437 ± 104 Hounsfield units (HU) (group I), 448 ± 111 HU (group II), and 447 ± 106 HU (group III), with P ≥ 0.18. Extravasation occurred in none of the patients. Median (interquartile range) for comfort, pain, and stress was, respectively, 4 (4-5), 0 (0-0), and 1 (1-2), with P ≥ 0.68.
  
  
  
  High flow rates of prewarmed CM were safely injected without discomfort, pain, or stress. Therefore, the use of high flow rates should not be considered a drawback for CM administration in clinical practice.
authors.affiliation: From the *Department of Radiology, †CARIM, School for Cardiovascular Diseases, and ‡Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Kok
authors.forename: Casper
authors.initials: C
authors.lastname: Mihl
authors.forename: Babs M F
authors.initials: BM
authors.lastname: Hendriks
authors.forename: Sibel
authors.initials: S
authors.lastname: Altintas
authors.forename: Nienke G
authors.initials: NG
authors.lastname: Eijsvoogel
authors.forename: Bas L J H
authors.initials: BL
authors.lastname: Kietselaer
authors.forename: Joachim E
authors.initials: JE
authors.lastname: Wildberger
authors.forename: Marco
authors.initials: M
authors.lastname: Das
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072226:Computed Tomography Angiography / Q000379:methods*; D003287:Contrast Media / Q000008:administration & dosage*; D017023:Coronary Angiography / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007472:Iohexol / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000139:chemically induced*; D000070659:Patient Comfort; D011856:Radiographic Image Enhancement / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide