Effective Adaptation of Ventilation Maneuvers in Electroconvulsive Therapy Sessions During the Coronavirus Disease 2019 Pandemic.

The coronavirus disease 2019 pandemic forced the adaption of the electroconvulsive therapy (ECT) technique. Several proposals have been generated to specifically address droplet dispersion during airway management[1,2] in modified ECT. Some authors recommend avoiding or minimizing hyperventilation during the pandemic, as it is typically performed by manual bag-mask ventilation (BMV),[1] which is an aerosol-generating or droplet dispersion procedure.[3,4]

In the ECT Unit of the Bellvitge University Hospital, the ECT procedure was adapted by a multidisciplinary team following the available recommendations,[1,5] local coronavirus disease 2019 guidelines, and current literature. The ventilation procedure was modified to address the reduction of aerosol-generating BMV and isolation of possible droplets. It used a modified ventilation protocol (see video in Supplemental Digital Content, http://links.lww.com/JECT/A117, http://links.lww.com/JECT/A118) that included the following:

Preoxygenation followed by 2-minute voluntary hyperventilation asking patients to hyperventilate to decrease carbon dioxide basal values before anesthetic induction. Both procedures were performed with a single-use standard nasal cannula with supplemental oxygen flow (4 L/min) while wearing a protective surgical facemask.[6]

Ventilation and airway manipulation isolation were performed during all of the treatment with the patient asleep using a single-use disposable waterproof plastic cover with a hole to connect the disinfected bag mask and antimicrobial air filter.

Energetic BMV manual hyperventilation was avoided after anesthetic induction and mouth manipulation to introduce the Guedel cannula; if possible, we used a mouth guard that allowed ventilation through the guard. Oxygenation[3] and manual ventilation assistance with a tight sealed BMV were maintained under the plastic tent until the patient emerged from anesthesia.

This modified ventilation protocol effectively induced adequate seizures despite avoiding energetic hyperventilation[7] without eliciting significant side effects. This reinforces the importance of preoxygenation[8] and the role of voluntary hyperventilation[9] performed actively by the patient before anesthesia induction to help to maintain a good oxygenation during ECT treatments.