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. 2020 Nov 1:276:241-248.
doi: 10.1016/j.jad.2020.06.051. Epub 2020 Jul 15.

Electroconvulsive therapy protocol adaptation during the COVID-19 pandemic

Joaquín Gil-Badenes  1 , Ricard Valero  2 , Marc Valentí  3 , Elisabet Macau  4 , Maria Jesús Bertran  5 , Gerard Claver  6 , Miquel Bioque  7 , Inmaculada Baeza  8 , Anna Bastidas Salvadó  9 , María Lombraña Mencia  10 , Isabella Pacchiarotti  3 , Miquel Bernardo  7 , Eduard Vieta  11
Affiliations

Electroconvulsive therapy protocol adaptation during the COVID-19 pandemic

Joaquín Gil-Badenes et al. J Affect Disord. .

Abstract

Background: During the COVID-19 pandemic, electroconvulsive therapy units have had to confront challenges such as the infectious hazard due to aerosol-generating ventilation, or the lack of staff and material resources. Our objective was to elaborate a protocol to make ECT during the COVID-19 pandemic a safer procedure for patients and professionals.

Methods: A multidisciplinary workgroup (including mental health, anesthesia, preventive medicine, and occupational risk professionals) was formed in the Hospital Clínic de Barcelona, in March 2020. A core group conducted a review of the scientific literature and healthcare organizations' guidelines and wrote a protocol draft. Then, a discussion with the workgroup was made until consensus was reached. The protocol has been continuously updated. Discussions were made by group e-mailing and video conferencing.

Results: The protocol includes the following main areas: (1) ECT unit's structural and functional considerations; (2) SARS-CoV-2 screening protocol; (3) ECT clinical practice adaptation (personal protective equipment, airway management, recovery room, and maintenance of the facilities); (4) management of COVID-19 cases; and (5) protocol assessment.

Limitations: The literature review was not systematic; the consensus was not based on a structured methodology. For other ECT units, local advisories may not be valid, and resource shortages (such as anesthetist availability, or the lack of respirators and PCR tests) may impede or prevent their implementation.

Conclusions: During the COVID-19 pandemic, ECT should continue to be advocated as an essential medical procedure. It is recommended that each ECT unit develop its own protocol. This proposal may be used as a reference.

Keywords: COVID-19; Coronavirus; ECT; Electroconvulsive therapy; Protocol; SARS-CoV-2.

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Conflict of interest statement

JGB has received financial support for traveling and educational activities from Adamed, Italfármaco, Lundbeck, and Janssen. JGB has served as a consultant or provided teaching materials to Sanofi and Casen Recordati.

MV has received research grants from Eli Lilly & Company and has served as a speaker for Abbott, Bristol-Myers Squibb, GlaxoSmithKline, Janssen-Cilag, and Lundbeck.

M. Bioque has been a consultant for, received grant/research support and honoraria from, and been on the speaker/advisory board or has received honoraria from talks and/or consultancy of Adamed, Angelini, Ferrer, Janssen-Cilag, Lundbeck, Otsuka, Pfizer, and Sanofi.

IP has received CME-related honoraria or consulting fees from ADAMED, Janssen-Cilag, and Lundbeck and reports no financial or other relationship relevant to the subject of this article.

M. Bernardo has been a consultant for, received grant/research support and honoraria from, and been on the speakers/advisory board of ABBiotics, Adamed, Angelini, Casen Recordati, Janssen-Cilag, Menarini, and Takeda.

EV has received grants and served as consultant, advisor, or CME speaker for the following entities: AB-Biotics, Abbott, Allergan, Angelini, AstraZeneca, Bristol-Myers Squibb, Dainippon Sumitomo Pharma, Farmindustria, Ferrer, Forest Research Institute, Galenica, Gedeon Richter, Glaxo-Smith-Kline, Janssen, Lundbeck, Otsuka, Pfizer, Roche, Sage, Sanofi-Aventis, Servier, Shire, Sunovion, Takeda, The Brain and Behavior Foundation, the Generalitat de Catalunya (PERIS), the Spanish Ministry of Science, Innovation, and Universities (CIBERSAM), EU Horizon 2020, and the Stanley Medical Research Institute, unrelated to the present work.

All other authors declare that they have no conflicts of interest.

Figures

Fig 1
Fig. 1
ECT unit's SARS-CoV-2 screening protocol.
Fig 2
Fig. 2
Airway box placed to reduce aerosol generation during manual ventilation.
See this image and copyright information in PMC

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