Electroconvulsive therapy practice during the COVID-19 pandemic

Abstract

scientists had isolated a new type of coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), from these patients. It was hypothesized that the outbreak was associated with a seafood market in Wuhan (1).China promptly adopted public health measures to prevent and control the epidemic, including isolating patients, monitoring their contacts, and developing diagnostic and treatment procedures (2). However, the number of confirmed cases continued to increase, and the disease spread to other countries.The first cases of coronavirus disease (COVID-19) outside China were reported in Thailand, Japan, and Korea. Since then, COVID-19 has spread to American and European territories. By the time the World Health Organization declared a pandemic on March 11, 2020, there were approximately 118,000 cases of COVID-19, with 4,291 deaths in 114 countries (1).In the American continent, the first case was reported in the United States of America on January 21, 2020, followed by Canada, which reported its first case four days later. In South America, the first case was confirmed on February 26, 2020 in the city of São Paulo, Brazil. By May 7, 2020, the country had already 135,106 confirmed cases and 9,146 deaths (3). However, these numbers are likely underreported. In addition to the absence of proper screening mechanisms for asymptomatic patients (4), Brazil's health system suffers from a chronic lack of testing for suspected cases and deaths, as is the case in a number of developing countries.

Electroconvulsive therapy services during COVID-19 pandemic

“…All ECT centers worldwide have adopted the policy of universal safety precautions for administration of ECT during COVID-19 due to possible false-negative test results and asymptomatic carriers. Recommendations for full PPE include N95/ FFP2 (or higher) masks, face-shields, eye goggles, fluid-resistant long-sleeved gowns, and double gloves for all members who are actively involved in ECT administration ( Bellini et al, 2020 ; Bryson and Aloysi, 2020 ; Burhan et al, 2020 ; Chevance et al, 2020 ; Colbert et al, 2020 ; Flexman et al, 2020 ; Gil-Badenes et al, 2020 ; Lapid et al, 2020 ; Schumann et al, 2020 ; Sienaert et al, 2020 ; Tor et al, 2020a , b ; Purushothaman et al, 2020 ). The housekeeping staff involved in disinfection of the ECT room should wear at least N95/ FFP2 (or higher) face masks and gloves and limit their exposure to the bare minimum ( Lapid et al, 2020 ).…”

“…Many centers limited the number of patients per day to three to six ( Bryson and Aloysi, 2020 ; Gil-Badenes et al, 2020 ). The frequency of sessions for an individual patient is also kept at two per week ( Bellini et al, 2020 ; Gil-Badenes et al, 2020 ; Tor et al, 2020a , b ). Age-based determination of seizure threshold is suggested to reduce the number of ECT sessions ( Lapid et al, 2020 ).…”

“…There is a controversy regarding the dose of muscle relaxant. A lesser quantity reduces the apneic time and subsequent BMV, while a more liberal dose ensures complete muscle relaxation ( Bellini et al, 2020 ; Thiruvenkatarajan et al, 2020a , b ).…”

“…Apneic ventilation with BMV is a source of aerosolization ( Tran et al, 2012 ). To avoid BMV, some centers adopt a more extended period of preoxygenation and/or self-hyperventilation, or use head straps for holding the mask and avoiding BMV completely ( Bellini et al, 2020 ; Flexman et al, 2020 ; Lapid et al, 2020 ; Sienaert et al, 2020 ; Gil-Badenes et al, 2020 )) and restrict BMV to cases with desaturation ( Luccarelli et al, 2020 ). Others recommend to continue using low tidal volume BMV along with preoxygenation, provided a high-quality mask seal is achieved ( Bryson and Aloysi, 2020 ; Schumann et al, 2020 ; Tor et al, 2020a , b ; Gil-Badenes et al, 2020 .).…”

Electroconvulsive Therapy During the COVID-19 Pandemic

“…In such circumstances, psychiatry found itself faced with various challenges, one of them being the preservation of the continuity of electroconvulsive therapy (ECT) in patients with severe or refractory psychiatric disorders. ECT is still considered as one of the most effective and safest therapeutic interventions in psychiatry, especially in life threatening conditions that require a rapid therapeutic response (significant suicidality, progressive clinical deterioration, catatonia) [2]. In addition, it is extremely important for patients suffering from severe depression, schizophrenia or mania, that have an unsatisfactory therapeutic response to medication and/or psychotherapy [3][4][5].…”