The Clinical Alliance and Research in Electroconvulsive Therapy Network

Martin, Donel; Gálvez, Verònica; Lauf, Shani; Dong, Vanessa; Baily, Stephen A.; Cardoner, Narcı́s; Chan, Herng N.; Davidson, D.; Fam, Johnson; Felice, Nick De; Martínez‐Amorós, Èrika; Mohan, Titus; Ramalingam, Jothi; Sarma, Shanthi; Tor, Phern‐Chern; Waite, Susan; Loo, Colleen

doi:10.1097/yct.0000000000000435

Cited by 49 publications

(28 citation statements)

References 37 publications

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“…Therefore, we used the model that included "Patient" as a random effect as a null model (Null model 0), and we used it as a reference when selecting which factors were regarded as variables of interest and were introduced as fixed terms. The following approach was computed for every dependent variable (SQI [31], SAMS [22], and PSIr [49,50]) to detect which independent factors (sociodemographic, clinical, and procedural variables) predicted each outcome; separately for each factor, we calculated a mixed model that included the factors as fixed terms adjusted by individual as a random effect (univariate analysis). Furthermore, a multivariate model including all the variables that were statistically significant in the univariate models (p-value < 0.05) was implemented.…”

Section: Discussionmentioning

confidence: 99%

“…As these indexes might be altered by artefacts during the recording, the motor and EEG seizure duration plus the postictal suppression rating (PSIr) were visually determined by a psychiatrist with expertise in ECT. The PSIr was analyzed by a single rater using a Likert scale (0-3), with examples and descriptors of the levels of quality [49] based on the Nobler et al [50] approach.…”

Section: Evaluation Of Seizure Adequacy Parametersmentioning

confidence: 99%

“…ASTI, time interval from anesthesia induction to electrical stimulation; mC, millicoulombs; ms, milliseconds; SD, standard deviation. †[49,50].…”

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confidence: 99%

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Factors Predicting Ictal Quality in Bilateral Electroconvulsive Therapy Sessions

et al. 2021

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In electroconvulsive therapy (ECT), ictal characteristics predict treatment response and can be modified by changes in seizure threshold and in the ECT technique. We aimed to study the impact of ECT procedure-related variables that interact during each session and might influence the seizure results. Two hundred and fifty sessions of bilateral ECT in forty-seven subjects were included. Seizure results were evaluated by two different scales of combined ictal EEG parameters (seizure quality index (SQI) and seizure adequacy markers sum (SAMS) scores) and postictal suppression rating. Repeated measurement regression analyses were performed to identify predictors of each session’s three outcome variables. Univariate models identified age, physical status, hyperventilation, basal oxygen saturation, days between sessions, benzodiazepines, lithium, and tricyclic antidepressants as predictors of seizure quality. Days elapsed between sessions, higher oxygen saturation and protocolized hyperventilation application were significant predictors of better seizure quality in both scales used in multivariate models. Additionally, lower ASA classification influenced SQI scores as well as benzodiazepine use and lithium daily doses were predictors of SAMS scores. Higher muscle relaxant doses and lower applied stimulus intensities significantly influenced the postictal suppression rating. The study found several modifiable procedural factors that impacted the obtained seizure characteristics; they could be adjusted to optimize ECT session results.

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Section: Discussionmentioning

confidence: 99%

Section: Evaluation Of Seizure Adequacy Parametersmentioning

confidence: 99%

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Factors Predicting Ictal Quality in Bilateral Electroconvulsive Therapy Sessions

et al. 2021

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“…In the era of personalized medicine and international consortia, such as The Global ECT-MRI Research Collaboration (GEMRIC) [55], the Genetics of Electroconvulsive Therapy International Consortium (Gen-ECT-ic) [56], and the Clinical Alliance and Research in ECT Network (CARE) [57], we have an exceptional opportunity to further evaluate the neurobiological underpinnings of ECT-related cognitive side effects.…”

Section: Discussionmentioning

confidence: 99%

The Neurobiological Basis of Cognitive Side Effects of Electroconvulsive Therapy: A Systematic Review

et al. 2021

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Decades of research have consistently demonstrated the efficacy of electroconvulsive therapy (ECT) for the treatment of major depressive disorder (MDD), but its clinical use remains somewhat restricted because of its cognitive side effects. The aim of this systematic review is to comprehensively summarize current evidence assessing potential biomarkers of ECT-related cognitive side effects. Based on our systematic search of human studies indexed in PubMed, Scopus, and Web of Knowledge, a total of 29 studies evaluating patients with MDD undergoing ECT were reviewed. Molecular biomarkers studies did not consistently identify concentration changes in plasma S-100 protein, neuron-specific enolase (NSE), or Aβ peptides significantly associated with cognitive performance after ECT. Importantly, these findings suggest that ECT-related cognitive side effects cannot be explained by mechanisms of neural cell damage. Notwithstanding, S-100b protein and Aβ40 peptide concentrations, as well as brain-derived neurotrophic factor (BDNF) polymorphisms, have been suggested as potential predictive biomarkers of cognitive dysfunction after ECT. In addition, recent advances in brain imaging have allowed us to identify ECT-induced volumetric and functional changes in several brain structures closely related to memory performance such as the hippocampus. We provide a preliminary framework to further evaluate neurobiological cognitive vulnerability profiles of patients with MDD treated with ECT.

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“…Seizure characteristics were determined by 2-channel electroencephalogram (EEG), duration and postictal suppression index (PSI) were provided by the Thymatron device, and the motor and EEG seizure duration plus the postictal suppression rating (PSIr) using a 0–3 scale 16 , 17 were determined visually by a psychiatrist with expertise in ECT.…”

Section: Methodsmentioning

confidence: 99%

Ventilation Adjustment in ECT During COVID-19: Voluntary Hyperventilation is an Effective Strategy

Arriba-Arnau¹,

Llitjos²,

Soria³

et al. 2021

NDT

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Purpose: Airway management is a key objective in adapted electroconvulsive therapy (ECT) protocols during the COVID-19 pandemic to prevent infection. The objective of this study was to describe the effectiveness of a modified ventilation procedure designed to reduce aerosol-generating bag-mask ventilation (BMV) and isolate possible droplets while maintaining adequate respiratory gas values in ECT sessions. Materials and Methods: This prospective study analyzed the results of the modified protocol applied over a month. Adaptations entailed preoxygenation and extension of the voluntary hyperventilation (VHV) time for two minutes before anesthesia induction, asking patients to hyperventilate with oxygen therapy via nasal cannula and while wearing a face mask. Thereafter, vigorous hyperventilation was avoided, and patients were only assisted with tightly sealed BMV until emergence from anesthesia, isolating the ventilation by using a single-use plastic device. Oxygen saturation (SpO 2 ) and transcutaneous partial pressure of carbon dioxide (TcPCO 2 ) were recorded throughout the session. Results: The study included 74 sessions of bilateral ECT with the modified ventilation protocol in 15 subjects. After VHV, the mean SpO 2 increase was 2.12±2.14%, and the mean TcPCO 2 decrease was 4.05±2.98 mmHg. TcPCO 2 values at the moment of stimulus administration were 2.22±3.07 mmHg below pre-ECT values. The mean EEG seizure was 38.70 ±17.03 s, and postictal suppression was 68.31± 34.58% and 2.13±0.75 on a 0-3 scale. Brief desaturation (SpO 2 <90) of 4-5 seconds duration was observed in 4 sessions. Conclusion: This modified ventilation protocol was effective during COVID-19, and it did not elicit significant side effects. In addition to avoiding vigorous BMV, it induced moderate hypocapnia, which has been tied to seizure optimization and less hypercapnia during the apnea period.

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The Clinical Alliance and Research in Electroconvulsive Therapy Network

Cited by 49 publications

References 37 publications

Factors Predicting Ictal Quality in Bilateral Electroconvulsive Therapy Sessions

Factors Predicting Ictal Quality in Bilateral Electroconvulsive Therapy Sessions

The Neurobiological Basis of Cognitive Side Effects of Electroconvulsive Therapy: A Systematic Review

Ventilation Adjustment in ECT During COVID-19: Voluntary Hyperventilation is an Effective Strategy

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