ECT During Covid- More From Brazil

Out on Pubmed, from clinicians in Belo Horizonte, Brazil, is this LTE:

The pdf (in Portuguese) is here.

Some of the translated text is below:

Electroconvulsive therapy (ECT) is a procedure indicated for the treatment of various neuropsychiatric disorders, including life-threatening disorders and situations, such as depression with risk of suicide or malnutrition, catatonia, refractory schizophrenia, mania with psycho agitation -serious motor and epilepticus.1 Although it is a life-saving treatment, continuing ECT services during the COVID-19 pandemic has been a challenge due to the intrinsic risks of anesthesia and approaching the airways during the procedure.2 it consists in the use of a short acting hypnotic agent (propofol, etomidate or thiopental) followed by a neuromuscular blocker, the most used being succinylcholine due to the rapid onset and termination of action. Oxygen supply is provided through non-invasive balloon-mask ventilation.3 This is the critical point in the procedure because non-invasive ventilation poses a greater risk of contamination due to aerosol release by infected patients. To face the challenge, some services are using Laryngeal Mask (ML) for ventilation, others are trying not to ventilate patients during the procedure, using pre - oxygenation via mask, not rebreather. The latter can be dangerous because the patient's oxygen saturation may drop to a level that requires some type of ventilatory support. Although the procedure is fast enough to allow the use of ML, the risk of decontamination due to aerosol spray does not significantly decrease; in addition, ML can induce the patient to cough.

In our ECT service, we modified the non-invasive ventilation technique (fig. 1) with the installation of a HEPA filter (High-Efficiency Particulate Arrestance) between the bag and the mask to retain the viral particles. In addition plastic surrounding the mask and the patient's face is fixed to the ventilation system. This device protects against aerosol that can escape between the mouth and mask and spread viral particles through the ECT room. The edge of the plastic bag can be fixed with clamps. All ventilation material is replaced between the care of one patient and another. The use of low O2 flow during ventilation is also recommended. The psychiatrist, anesthesiologist and nurses must all be wearing personal protective equipment such as N95 mask, face shield, gloves and impervious apron. We believe it is a safe and effective way to reduce the risk of contamination by COVID-19 during the procedure. 

This communication from colleagues in Brazil is yet another indication of diligent efforts around the world to continue to provide ECT during the pandemic. I have featured it mostly to show the photograph of the innovative plastic shield around the patient's face.

(Please see also blog post of October 23, 2020)