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AGHPS Position Statement

ECT during COVID-19

Following communication with multiple Schedule 1 Facilities across the province, it is clear that there is much variability in hospital response to the COVID-19 pandemic with regard to ECT programs.

For most patients receiving acute inpatient treatment with ECT or maintenance outpatient treatment ECT is not considered an elective procedure. Discontinuation will be associated with a high prevalence of relapse with significant impact on patients, families and health resources. For these reasons the AGHPS does not support the full cessation of ECT availability during current pandemic planning.

We support restricting ECT utilization for the highest risk patients:  

New starts- must be urgent, all other treatment options have been exhausted, there is severe impairment in function, catatonia, and/or a high risk of suicide.
Those who have already started and are still in the midst of an acute course of treatment – continue where it is safe enough for staff to do so
Maintenance treatment- all currently scheduled patients be reviewed to determine whether treatment should continue at all, or can treatment frequency be reduced. These clinical decisions to be based upon both risk of relapse, severity of relapse and other available treatment options.
COVID-19 positive patients or those that are screened positive should have treatment deferred until no longer requiring quarantine precautions.

ECT anaesthesia involves bag mask ventilation which carries a risk of aerosolization although the risk of aerosolization can be mitigated and reduced. It can potentially create an increased risk of exposure from patients who may be asymptomatic carriers. Enhanced PPE measures are required. Specific hospital protocols developed by infectious disease and anesthesia teams must be followed. The AGHPS supports the ongoing deployment of anaesthesia to the provision of essential ECT and urges a provincial consensus on PPE measures needed to deliver ECT treatment safely.

These guidelines will require review depending on health care resource limitations over the coming weeks/months.

The AGHPS is grateful to our colleagues who took time to assist in the development of this position statement.