Electroconvulsive therapy services during COVID-19 pandemic

Abstract

The COVID-19 pandemic has hit the electroconvulsive therapy (ECT) services hard worldwide as it is considered an elective procedure and hence has been given less importance. Other reasons include the risk of transmission of infections, lack of resources, and the scarcity of anesthesiologists due to their diversion to intensive care units to manage COVID-19 patients. However, ECT is an urgent and life-saving measure for patients diagnosed with depression and other severe mental illnesses who have suicidality, catatonia, or require a rapid therapeutic response. COVID-19 pandemic is a significant source of stress for individuals due to its impact on health, employment, and social support resulting in new-onset psychiatric illnesses and the worsening of a pre-existing disorder. Hence, a continuation of the ECT services during the COVID-19 pandemic is of paramount importance. In this narrative review, the authors from India have compiled the literature on the ECT practice during the COVID-19 pandemic related to the screening and testing protocol, necessity of personal protective equipment, modification in ECT Suite, electrical stmulus settings, and anesthesia technique modification. The authors have also shared their experiences with the ECT services provided at their institute during this pandemic. This description will help other institutes to manage the ECT services uninterruptedly and make ECT a safe procedure during the current pandemic.

Keywords: Anesthesia; COVID-19; ECT practice; Personal protective equipment.

Fig. 1

Patient commuted from ward to ECT facility in a battery-operated vehicle to facilitate a quick commute.

Fig. 2

Heat moisture exchange (HME) filter between the patient end of the Bain's/closed circuit and the anatomical reusable face mask (2A), patient end of the closed circuit and the mask (2B) and between the expiratory limb of the closed circuit and anesthesia workstation (2C).

Fig. 3

Barrier methods for ECT administration using Acrylic box (3A), & plastic sheet (3B). Oxygen administration using highflow oxygen therapy with nasal cannula underneath the surgical mask (3C,D).