AUTHOR=Hajak Vivien L. , Hajak Göran , Ziegelmayer Christoph , Grimm Simone , Trapp Wolfgang 

TITLE=Risk Assessment of Electroconvulsive Therapy in Clinical Routine: A 3-Year Analysis of Life-Threatening Events in More Than 3,000 Treatment Sessions

JOURNAL=Frontiers in Psychology

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2021.767915

DOI=10.3389/fpsyg.2021.767915

ISSN=1664-1078

ABSTRACT=Background: Extensive research has found electroconvulsive therapy (ECT) to be highly effective in approximately 80 percent of patients suffering from depression. Its clinical use is mainly limited by historical objections and the concern about unwanted adverse effects (AEs), including serious and potentially life-threatening adverse events (pLTAEs) induced either by ECT or anesthesia. Objective risk estimation is, therefore, a decisive factor in determining the indication for ECT.
Methods: This paper presents a retrospective analysis of 3-years safety protocols and patient files of 157 patients who received a total of 3,106 ECT applications in a psychiatric inpatient setting at a psychiatric community hospital. This patient group compromises 5.3% of inpatients admitted with comparable diagnoses. Adverse events were analyzed from standardized safety protocols and patient files with a focus on pLTAEs.
Results: For 30 (19.1%) of the 157 participants during 39 (6.1%) of 641 hospital stays, AEs were reported. Serious pLTAEs occurred during 3 electroconvulsive stimulations in three patients, who needed action through administration of medication or mechanical respiration. No patient suffered permanent damage to health, no patient died. Incidence of these and other AEs was independent of sex, age and diagnosis of patients, and anesthesia medication. Minor AEs occurred more often with higher stimulus doses and an increasing number of treatments.
Conclusion: The low incidence rate of 0.097% of serious pLTAEs that required medical action may allow the conclusion that ECT is a rather safe treatment when performed in a controlled setting. The in average as well as for single patients beneficial risk profile of ECT performed in the psychiatric standard of care hospitals suggests a more generous indication of this treatment method. We recommend that ECT facilities collect individual safety data to allow a reliable judgment of their institutional ECT risk profile.