Safety in electroconvulsive therapy: a narrative review of cardiopulmonary complications

Electroconvulsive therapy (ECT) is an effective and widely practiced treatment. As stigma surrounding the technique continues to diminish, it has become a therapeutic option for a broad range of psychiatric disorders, including in older and frail patients. With ECT increasingly delivered in ambulatory or remote settings, anesthesiologists and psychiatrists must remain aware of the potential cardiopulmonary complications that may arise during the procedure.

Although high-quality evidence is still limited, recent studies, often using heterogeneous methodologies, consistently underline the cardiopulmonary complications inherent to ECT and their rare but tragic result. However, no consensus has yet emerged regarding optimal anesthetic management or prevention strategies.

ECT is a safe and efficient therapeutic option, even for patients with significant comorbidities, and should be performed by well-trained multidisciplinary teams. Serious cardiopulmonary complications remain a rare event, but clinicians should be prepared to anticipate and manage them promptly to minimize morbidity and mortality.