Out on PubMed from James Luccarelli and colleagues in Boston is this study:
Modified Anesthesia Protocol for Electroconvulsive Therapy Permits Reduction in Aerosol-Generating Bag-Mask Ventilation during the COVID-19 Pandemic.
Modified Anesthesia Protocol for Electroconvulsive Therapy Permits Reduction in Aerosol-Generating Bag-Mask Ventilation during the COVID-19 Pandemic.
Psychother Psychosom. 2020 Jun 18:1-6. doi: 10.1159/000509113. Online ahead of print.PMID: 32554959
The link to the abstract is above; the abstract is copied here:
Introduction: Electroconvulsive therapy (ECT) is a critical procedure in psychiatric treatment, but as typically delivered involves the use of bag-mask ventilation (BMV), which during the COVID-19 pandemic exposes patients and treatment staff to potentially infectious aerosols.
The link to the abstract is above; the abstract is copied here:
Introduction: Electroconvulsive therapy (ECT) is a critical procedure in psychiatric treatment, but as typically delivered involves the use of bag-mask ventilation (BMV), which during the COVID-19 pandemic exposes patients and treatment staff to potentially infectious aerosols.
Objective: To demonstrate the utility of a modified anesthesia protocol for ECT utilizing preoxygenation by facemask and withholding the use of BMV for only those patients who desaturate during the apneic period.
Methods: This chart review study analyzes patients who were treated with ECT using both the traditional and modified anesthesia protocols.
Results: A total of 106 patients were analyzed, of whom 51 (48.1%) required BMV using the new protocol. Of clinical factors, only patient BMI was significantly associated with the requirement for BMV. Mean seizure duration reduced from 52.0 ± 22.4 to 46.6 ± 17.1 s, but seizure duration was adequate in all cases. No acute physical, respiratory, or psychiatric complications occurred during treatment.
Conclusions: A modified anesthesia protocol reduces the use of BMV by more than 50%, while retaining adequate seizure duration.
This manuscript is noteworthy for providing substantial clinical data, not just suggestions or expert consensus recommendations about modifications to ECT anesthesia technique during the COVID pandemic. The key to the technique is excellent preoxygenation. If patients do begin to desaturate, they can be given a small number of assisted breaths.
When the need for extraordinary infection control measures is no longer necessary in the post-COVID era, then the usual practice of peri-procedural hyperventilation for seizure enhancement can be resumed.
When the need for extraordinary infection control measures is no longer necessary in the post-COVID era, then the usual practice of peri-procedural hyperventilation for seizure enhancement can be resumed.
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