Fire safety and ECT: A review of the safety record and the creation of an evidenced-based safety protocol [Meeting Abstract]
Objective: To review issues with ECT and fire safety. Background: Regulatory agencies are increasing concerned with fire safety in procedural areas. While surgical lasers and electrocautery are more common culprits, ECT may come to the attention of internal and external agencies. ECT providers will need to respond to inquiries about fire safety and demonstrate safety protocols. Design/Methods: We reviewed the literature on fire safety and ECT as well as the Food and Drug Administration's Manufacturer and User Facility Device Experience for adverse events regarding ECT, fire or burns. We developed a fire-safety protocol based on our findings. Results: There are no reports of fire in the FDA database with either of the two commercially available machines in the United States. We discovered only two reported cases of fires related to ECT from the time period of 1992-2015, and none in the last ten years. In the both reported cases, the presence of 100% oxygen has been implicated as an important factor. There are roughly 26 cases of burns or suspected burns reported to the FDA between 1992-2015. Many of these burns appear to be related to improper use of adhesive electrodes or improper preparation of the treatment site. Fire safety in procedural areas focuses on reducing the three components required for ignition: spark, fuel source and oxygen. We adapted these concepts in creating a fire-safety protocol for ECT. Conclusions: Fires and burns are an extremely rare complication in ECT. A reasonable fire-safety protocol can reduce this risk even further
Recurrent Aspiration in a Patient With Gastric Band Undergoing Electroconvulsive Therapy
We report a case of a 33-year-old woman with depression and suicidal ideation, treated successfully with electroconvulsive therapy (ECT) in the past. Since her previous course of ECT, she underwent gastric banding, a bariatric surgical procedure associated with increased risk of gastric regurgitation. Despite increasingly stringent measures to minimize the risk of regurgitation and aspiration during ECT, she had several episodes of regurgitation, the last of which precipitated an acute illness consistent with aspiration pneumonitis. We took additional precautions after each event, until she had no further episodes of regurgitation. We discuss the risk posed by the gastric band, the measures we implemented to minimize that risk, and our recommendations for assessment and management of post-gastric banding patients who present for ECT.