Predictors of post-electroconvulsive therapy delirium: a prospective randomized study from an Indian tertiary care...

Post-electroconvulsive therapy (ECT) delirium is a clinically important adverse effect occurring during early recovery following ECT. The objective of the study was to identify the predictors of early post-ECT delirium, including the role of thiopental, propofol and etomidate.

A prospective randomized parallel-group clinical trial was conducted in a tertiary care ECT unit between January 2023 and May 2024. Ninety adult patients undergoing ECT were randomly allocated into Propofol, Etomidate, and Thiopental anesthetic groups (n = 30 each). Participants were blinded to treatment allocation, whereas outcome assessors were not blinded. Delirium was assessed at 15 and 30 min following eye opening using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) together with the Richmond Agitation-Sedation Scale (RASS). Exploratory multivariable logistic regression was performed to identify predictors of delirium at 15 min. The study was prospectively registered with the Clinical Trials Registry-India (CTRI/2023/01/049228).

Early post-ECT delirium occurred in 65 patients (72.2%) at 15 minutes, whereas only 11 patients (12.2%) remained delirious at 30 min. Among patients with delirium at 15 min, 54 (83.1%) recovered by 30 min. Longer seizure duration remained independently associated with increased odds of delirium at 15 min (adjusted OR = 1.09, 95% CI: 1.04-1.18, p = 0.004). Compared with propofol, thiopental (OR = 0.04, 95% CI: CI:0.01-0.20, p < 0.001) and etomidate (OR = 0.06, 95% CI: CI:0.01-0.46, p = 0.008) demonstrated lower adjusted odds of delirium.

Early post-ECT delirium was common but predominantly transient during immediate recovery. Larger multicenter studies with longitudinal follow-up are required to confirm these findings.