Correlation between ECT quality measures & likelihood to transition from acute to maintenance ECT

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Abstract Title: Correlation between ECT quality measures & likelihood to transition from acute to continuation ECT and then to maintenance ECT Background Electroconvulsive therapy (ECT) uses an electric current to induce a generalized seizure under general anesthesia to treat psychiatric conditions including major depressive disorder, bipolar disorder, schizophrenia, schizoaffective disorder, and catatonia. In the current literature, there is a lack of consensus regarding which quality measures can reliably predict clinical outcomes. Some proposed markers for effective ECT include seizure duration greater than 25 seconds, high postictal suppression (i.e. extent to which EEG activity diminishes after the seizure ends), and a larger magnitude of difference between baseline and peak heart rates during the procedure. Methods Our study is a retrospective medical record review of all patients who started ECT at CHI Health Immanuel Hospital between July 2016 and July 2019. We gathered data on patient demographics, psychiatric diagnoses, ECT parameters (electrode placement, pulse width, energy level) and ECT quality measures (seizure duration, postictal suppression, and heart rate response). Treatment sessions were categorized into three groups to measure progression through ECT treatment: acute, continuation, and maintenance. Acute treatment involves receiving ECT 2-3 times weekly for at least 4 weeks. Continuation treatment receives ECT once every 1-4 weeks for 6 months after the last acute treatment. Maintenance ECT undergoes treatment once every 1-4 weeks after completing continuation treatment. Independent variables are ECT quality measures at each treatment. The primary outcome is time to transition from acute to continuation to maintenance. Results 2,506 ECT encounters were observed for 114 patients. Data were analyzed using the proportional odds assumption. After adjusting for postictal suppression index (PSI) and HR change, a 10-second longer seizure duration was associated with 10% higher odds of progressing to the next ECT category (p <.001). After adjusting for seizure duration and HR change, every 10-unit increase in PSI was associated with 7% higher odds of progressing to the next ECT category (p = 0.009). After adjusting for seizure duration and PSI, a 10 bpm increase in HR change was associated with 4% higher odds of being in the next higher ECT category (p = 0.174). Conclusion Our study found that longer seizure duration and higher PSI were associated with higher odds of progressing through ECT treatment.