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Pupillary Response as Assessment of Effective Seizure Induction by Electroconvulsive Therapy

Pupillary Response as Assessment of Effective Seizure Induction by Electroconvulsive Therapy

Published on: April 11, 2019

Pulseless electrical activity during electroconvulsive therapy: a case report.

Arun Kalava¹, Allison Kalstein, Sander Koyfman

¹Department of Anesthesiology, New York Methodist Hospital, 506, 6th street, Brooklyn, NY, 11215, USA. arunkalava@yahoo.com.

BMC Anesthesiology

|June 2, 2012

Summary

This case report details an 81-year-old female who experienced pulseless electrical activity during electroconvulsive therapy, a rare event. She survived a massive pulmonary embolism, highlighting the risks of tourniquet use in elderly patients.

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Area of Science:

Cardiology
Neurology
Geriatrics

Background:

Cardiac arrest during electroconvulsive therapy (ECT) is rare, with asystole being the most common initial rhythm.
Pulseless electrical activity (PEA) as an initial rhythm during ECT has not been previously reported.
Thromboembolism following tourniquet use during ECT has not been documented.

Purpose of the Study:

To report a unique case of PEA during ECT in an elderly patient.
To highlight the potential risk of thromboembolism associated with tourniquet use during ECT.
To suggest preventative measures for high-risk patients.

Main Methods:

Case report of an 81-year-old female undergoing ECT for severe depression.
Monitoring for cardiac events and resuscitation protocols.
Diagnostic workup for pulmonary embolism, including Doppler ultrasound.
Assessment of deep vein thrombosis (DVT) and embolic source identification.

Main Results:

The patient developed PEA immediately after ECT and was successfully resuscitated.
Bilateral pulmonary emboli were diagnosed, with occlusion of the right lower lobe pulmonary artery.
The source of the embolus was identified as a DVT in the left lower extremity, likely dislodged by tourniquet inflation.
The patient survived the event and showed significant improvement in mental status.

Conclusions:

Elderly patients at high risk for thromboembolism may benefit from preoperative Doppler ultrasound for DVT.
Selective tourniquet application in the upper limb during ECT could reduce the incidence of pulmonary thromboembolism.
Upper extremity DVTs pose a lower embolic risk compared to lower extremity DVTs.