Characterization of Flumazenil Utilization in Electroconvulsive Therapy

The primary objective was to evaluate the effectiveness of flumazenil administered after benzodiazepine treatment prior to a patient receiving electroconvulsive therapy (ECT). The secondary objective was to analyze the general practice of flumazenil administration in this patient population.

This retrospective chart review included patients who received at least one dose of a benzodiazepine 18 hours prior to ECT while admitted to a behavioral health unit from July 1, 2018, to June 30, 2023. The primary outcome examined seizure duration. Secondary outcomes included change in electrode placement, induction agent, and/or ECT machine, as well as addition of caffeine.

A total of 847 patient encounters were included in the final analysis, with 407 encounters with flumazenil and 440 without flumazenil. The median seizure duration was 33 seconds for the flumazenil cohort and 37.5 seconds for the no flumazenil cohort (P = 0.047). Patients who received flumazenil were more likely than not to experience a change in electrode placement (P = 0.005) and change in ECT machine (P = 0.001).

There were statistically significant differences between the two cohorts, with flumazenil being associated with a higher stimulus dose and a shorter seizure duration. The results of this study suggest a smaller impact of flumazenil on benzodiazepine-treated ECT patients than expected. Further studies are needed to explore the utility of flumazenil in this population.