THRIVE Oxygenation System in ECT: Unconvincing Case Report

 Out on PubMed,


Prevention of Oxygen Desaturation in a Patient With Previous Experience of Severe Hypoxia in Modified Electroconvulsive Therapy by Transnasal Humidified Rapid-Insufflation Ventilator Exchange: A Case Report.

Toyota Y, Kondo T, Narasaki S, Miyoshi H, Tsutsumi YM.Cureus. 2024 May 18;16(5):e60564. doi: 10.7759/cureus.60564. eCollection 2024 May.PMID: 38887347 


The abstract is copied below:

Transnasal humidified rapid-insufflation ventilator exchange (THRIVE) has been reported to have better efficacy during anesthesia induction compared to conventional mask ventilation, including improved oxygenation and prolonged safe apnea time. This study reports on the effectiveness of the THRIVE system during modified electroconvulsive therapy (mECT) for a patient experiencing severe hypoxia. A 78-year-old female patient with bipolar disorder received maintenance mECT every four weeks. She previously experienced a significant hypoxic event, with oxygen saturation (SpO2) dropping to 50% following electrical stimulation. In response, we employed the THRIVE system, designed to deliver high-flow, 100% oxygen, thereby extending apnea tolerance. The implementation of THRIVE ensured a stable oxygen supply, maintaining oxygen saturation levels above 95% throughout the mECT procedure. THRIVE is useful for treating hypoxia that occurs due to the unavoidable lack of ventilation during mECT.

Keywords: apneic oxygenation; electroconvulsive therapy; hfnc; hypoxia; thrive.

The article is here.
And from the text:








This case report purports to show the superiority of the THRIVE system over conventional manual bag-mask ventilation.
While THRIVE may work, and be an alternative in some situations, IMO, this report merely demonstrates suboptimal practice and lack of expertise in conventional airway management.
The text also incorrectly states that bag-mask ventilation must be stopped during the seizure, not just during stimulus delivery, which is incorrect.
Better to concentrate on keeping it simple (unless there is a true need to deviate from standard practice) and to utilize expert airway management skills.



Comments

  1. Sascha SartoriusJune 27, 2024 at 12:12 AM

    Yes, indeed, not too convincing. As we have learned from transcutaneous capnometry CO2 rises sharply after the stimulus, which is not addressed by THRIVE. And btw apnea tolerance can be increased very easily: Simply by extending the pre-oxygenation time before anesthesia induction. E.g. 5mins instead of 3 mins like it was done here. Or by increasing l/min rate during pre-stimulus bag-valving ... all easy to implement ...

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