Modified Anesthesia Protocol for Electroconvulsive Therapy Permits Reduction in Aerosol-Generating Bag-Mask Ventilation during the COVID-19 Pandemic

Abstract

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.

Keywords: COVID-19; Cohort studies; Electroconvulsive therapy; General anesthesia; Mechanical ventilation.

Fig. 1.

Plot of seizure duration prior to and following the protocol change reducing the use of bag-mask ventilation. Mean seizure duration reduces from 52.0±22.4s to 46.6±17.1s following the protocol change (P = 0.025, Wilcoxon signed-rank test). Box and whiskers plots encompass 95% of the data with remaining values shown as points.