Pulseless electrical activity during electroconvulsive therapy: a case report

Abstract

BackgroundArrhythmias resulting in cardiac arrest during electroconvulsive therapy have been reported. Most reported cases of cardiac arrest had asystole as the initial rhythm. Pulseless electrical activity as an initial rhythm of cardiac arrest during electroconvulsive therapy has never been reported. Also, thromboembolism after inflation of pneumatic tourniquet during lower limb surgery has been reported but never following tourniquet inflation during an electroconvulsive therapy.Case presentationWe report a case involving an 81- year- old female who presented to us for an electroconvulsive therapy for severe depression and developed pulseless electrical activity immediately after electroconvulsive therapy. She was successfully resuscitated and was later found to have bilateral pulmonary emboli with a complete occlusion of the right lower lobe pulmonary artery. The source of embolus was from her left lower extremity deep venous thrombus, which we believe, got dislodged intraoperatively after inflation of pneumatic tourniquet. Our patient not only survived the massive pulmonary embolus, but also showed significant improvement in her mental status compared to her pre-admission level at the time of discharge to a sub-acute rehabilitation centre.ConclusionWe recommend that patients who are elderly and at high risk of thromboembolism should selectively undergo a preoperative doppler ultrasound for deep venous thrombosis. Also, selective application of tourniquet in the upper limb, to monitor for seizure activity, would reduce the incidence of pulmonary thrombo-embolism as embolic events are significantly less from deep venous thromboses of upper extremities when compared to lower extremities.

Evaluation of the Efficacy of the ECT Patients Preparation Checklist in Reducing the Cancellation Rate in an Academic Hospital

“…Therefore, it is crucial that patients, especially the elderly and those with comorbidities, receive ECT under safe and optimal medical conditions (15,16). Several case reports have discussed how ECT patients were affected by unexpected hazardous situations, even death (17)(18)(19)(20). According to this study's results, 82 cases were canceled within the year before the intervention and 69 cases during the next year, when the checklist was provided to the psychiatrists the residents.…”

The impact of electroconvulsive therapy on the spatial QRS-T angle and cardiac troponin T concentration in psychiatric patients

“…Although ECT has been used in psychiatry for several decades, its safety has not been explicitly demonstrated [5–8, 19, 20].…”

“…One of the recent studies demonstrated elevated concentrations of cardiac troponins following ECT in several percent of patients [4]. Moreover, the literature reports acute ECT-related cardiovascular complications, such as myocardial infarction, ventricular arrhythmia, takotsubo cardiomyopathy, pulmonary embolism, and cardiac arrest in psychiatric patients[5–8].…”