Electroconvulsive therapy practice during the COVID-19 pandemic
DR.C. Panneer Selvan, MD, Director & Consultant Psychiatrist, Sneka Mind Care Institute, Tirunelveli
Published: Oct 8, 2020 11:57:59 AM IST
Updated: Oct 8, 2020 12:01:13 PM IST
Electroconvulsive therapy (ECT) is viewed as one of the best and safe interventions in psychiatry, especially for cases that require a quick restorative reaction, for example, those related with self-destructive ideation, progressive clinical disintegration, or mental shock. Such attributes have a few ramifications with regards to the COVID-19 pandemic. To begin with, ECT benefits regularly unite old and basically sick people, who have higher paces of clinical comorbidities, more unfortunate cleanliness (26), and worse intellectual profiles. This populace has a higher COVID-19 death rate.
It is well known that a pandemic can bring about a scope of mental morbidities in everyone. Likewise, extensive far reaching mental effect has been accounted for after an isolate period. Wang et al. announced that the greater part of 1,210 irregular subjects from 194 Chinese urban areas appraised their mental effect during the underlying phase of the COVID-19 flare-up as moderate to serious. Despite the lack of research, it is reasonable to hypothesize that individuals with a background marked by dysfunctional behavior might be more delicate to the mental impacts of a pandemic, expanding the danger of a psychological backslide.
In addition, during a pandemic, health assets are scant and non-crucial administrations might be shut or repurposed. In spite of its significance in hazardous circumstances, ECT has verifiably been delegated an elective treatment, so numerous ECT administrations might be restricted. This can have catastrophic consequences for patients with serious psychological health disorders; particularly thinking about that such a social setting can trigger and aggravate mental side effect. Unfortunately, a group from an overall clinic in has already reported the suicide of a patient of a patient with depression whose ECT treatment was hindered by restricted sedative assets as a result of the COVID-19 pandemic.
Another ramification for ECT units is identified with anesthetic practices required for the method. ECT is all around performed under general anesthesia, to give comfort and safety. After anesthetic induction, the patient's airway routes are normally kept up with bag-mask ventilation, though endotracheal intubation is seldom required. Such interventions, specifically non-obtrusive ventilation, may create a confined vaporized, which conveys a high danger of virus to those firmly engaged with the strategy. In this manner, there is a danger for the two patients and staff.
Precautions to continue ECT services during COVID-19 pandemic include:
Use of personal protective equipment (PPE) and anesthetic considerations
ECT is an aerosol generating procedure (AGP) and as such has considerations for the use of personal protective equipment (PPE). The use of PPE should continue whilst COVID-19 transmission remains a risk. PPE for staff in the treatment and recovery rooms should be as per national and local PPE guidelines
Whilst COVID-19 remains a potential risk, even if very small, cleaning is essential to infection control. Before commencing treatment of each patient, the following should be carefully cleaned:
ECT equipment (metal electrodes, stimulating lead, EEG leads, hand pieces, headband, ECT machine, ECT work area)
Anesthetic and monitoring equipment (tourniquet, pulse oximeter probe and lead, ECG leads)
All surfaces (ECT work area, anesthetic trolley, ECT and drug register area, beds).
Screening of patients and staff prior to procedures
Patients and staff should continue to be screened for COVID-19 symptoms. Depending on the resources and testing kits availability, routine testing for COVID-19 infection pre-procedure might be appropriate.
Adherence to physical distancing, as much as can be done with a procedure like ECT, should be retained for as long as these measures remain advised for the wider community.
Staff working in the delivery of ECT should follow organization protocols with regards to fitness to work in respect to COVID-19 pandemic, COVID-19 screening and PPE. Services are encouraged to identify back up staff members for each service so that so that ECT can continue in the event of unexpected staff shortages.
Thusly, there are numerous difficulties with the conveyance of ECT in the current COVID-19 pandemic. Useful procedures should be distinguished with the goal that ECT administrations can keep on working all through the COVID-19 pandemic, as indicated by accessible assets.
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