Intravenous Ketamine to Facilitate Transport of Agitated Patients to the ECT Clinic: Paper From Wales, in JECT

 Out on PubMed, from clinicians in Wales, is this paper:

Intravenous Ketamine to Facilitate Transport of Agitated Patients to the ECT Clinic.

Dean O, Byford-Brooks A, Hannigan K, Saunders D, Gamble W, Kirov G.J ECT. 2024 Nov 26. doi: 10.1097/YCT.0000000000001090. Online ahead of print.PMID: 39589116

The abstract is copied below:

Objectives: Electroconvulsive therapy (ECT) can be effective for a variety of psychiatric conditions, including for some patients who are very psychotic or agitated. Transferring such patients from the psychiatric ward to the ECT clinic can pose significant challenges for treating teams, as they try to minimize the use of restraint.

Methods: We developed a protocol for safe transfer of such patients using sedation with ketamine. An intravenous cannula is inserted on the ward in a low stimulus environment with gentle supportive holds. Intravenous ketamine is given in a bolus at 0.5-2.0 mg/kg. The patient is transported on a transfer bed to the ECT clinic within a few minutes, and usual ECT process is immediately followed.

Results: We describe 6 patients who were given between 1 and 11 ECT treatments using this method. All of them finished ECT courses without the need for ketamine sedation. Five of them regained capacity, provided informed consent for further ECTs, and eventually reached remission.

Conclusions: Ketamine can be used to manage risk and transfer agitated patients to an ECT clinic for treatment.

The paper is here.

And here:

This is a very useful paper with a detailed clinical protocol to use IV ketamine pre-ECT in agitated patients. Of course, IM ketamine may also be used, and this is mentioned.

Kudos to our colleagues in Cardiff for this contribution to the ECT literature.