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Vol. 70. Issue 6.
Pages 687-688 (01 November 2020)
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Vol. 70. Issue 6.
Pages 687-688 (01 November 2020)
Letter to the Editor
DOI: 10.1016/j.bjane.2020.08.010
Open Access
Occupational team safety in ECT practice during the COVID-19 pandemic
Segurança ocupacional da equipe na prática de ECT durante a pandemia de COVID-19
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Renato Ferreira Araujo
Corresponding author
ararenato@gmail.com

Corresponding author.
, Lucio de Oliveira Quites
Clínica Mangabeiras, Departamento de Eletroconvulsoterapia, Belo Horizonte, MG, Brazil
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Dear Editor,

Electroconvulsive Therapy (ECT) is a procedure indicated for the treatment of several neuropsychiatric conditions, including severe and life-threatening disorders and situations such as depression with risks of suicide or malnutrition, catatonia, refractory schizophrenia, mania with severe psychomotor agitation and status epilepticus.1 Although this is a life-saving treatment, maintaining the ECT services during the COVID-19 pandemic has become a challenge due to the intrinsic risks of anesthetics and airway management during the procedure.2 Anesthesia for ECT consists in the use of a short-acting hypnotic agent (propofol, etomidate, or thiopental) followed by a neuromuscular blocker, the most used is succinylcholine due to its rapid onset and offset of action. Oxygen supply is provided through a noninvasive bag and mask ventilation.3 This is a critical point in the procedure because noninvasive ventilation poses a higher risk of contamination due to aerosol release from contaminated patients. To address this challenge, some services are using a Laryngeal Mask (LMA) for ventilation, others are trying not to ventilate patients during the procedure, using preoxygenation via a non-rebreather mask. The latter can be dangerous because the patient’s oxygen saturation may drop to a level that requires some kind of ventilatory support. Although the procedure is fast enough to allow the use of LMA, the risk of contamination due to the aerosol spray does not decrease significantly; in addition, LMA can induce the patient to cough.4

In our ECT service, we modified the noninvasive ventilation technique (Fig. 1) by installing a HEPA (High-Efficiency Particulate Arrestance) filter between the bag and the mask to retain the viral particles. Additionally, a sterile plastic bag surrounding the mask and the patient’s face is attached to the ventilatory system. This device protects against the aerosol that may escape from between the mouth and the mask and spread viral particles around the ECT room. The edge of the plastic bag can be fixed with clamps. All ventilatory material is replaced among patients. The use of low O2 flow during ventilation is also a recommended measure. The psychiatrist, anesthesiologist, and nurses should all use personal protective equipment such as a N95 mask, face shield, gloves, and an impermeable gown.

Figure 1.

Technique to reduce the risk of contamination from COVID-19 during the ECT procedure.

(0.07MB).

We believe this is a safe and effective way to reduce the risk of contamination from COVID-19 during the ECT procedure.

Conflicts of interest

The authors declare no conflicts of interest.

References
[1]
R.T. Espinoza, C.H. Kellner, W.V. McCall.
Electroconvulsive therapy during COVID-19: an essential medical procedure-maintaining service viability and accessibility.
[2]
P.C. Tor, A.H.H. Phu, D.S.H. Koh, Y.M. Mok.
ECT in a time of COVID-19 [published online ahead of print, 2020 Mar 31].
J ECT., (2020),
[3]
American Psychiatric Association, R.D. Weiner.
Committee on electroconvulsive therapy.
The practice of electroconvulsive therapy: recommendations for treatment, training, and privileges: a task force report of the American Psychiatric Association, 2nd ed, American Psychiatric Association, (2001),
[4]
E.O. Bryson, A.S. Aloysi.
A strategy for management of ECT patients during the COVID-19 pandemic [published online ahead of print, 2020 May 12].
J ECT., (2020),
Copyright © 2020. Sociedade Brasileira de Anestesiologia
Idiomas
Brazilian Journal of Anesthesiology (English Edition)

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