Abstract
Background: Electroconvulsive therapy (ECT) is a safe and effective treatment for severe depression, which is often life-saving. Many experts in the field consider there to be no real absolute contraindications to ECT, but merely a list of relative contraindications. It is often a treatment of choice in the elderly, and many consider it as safe or safer than medication in the frail. Case reports of fatal outcomes following ECT are rare – mostly because this is a rare event. This paper aims to report three cases where the patients all died within a week of receiving their first and only treatment of ECT. The objective is to learn from these cases some of the factors which may predict a higher than normal risk of death related to ECT.
Method: The literature on mortality from ECT will be reviewed, and the patient factors most commonly associated with a fatal outcome identified. The three cases will then be briefly presented, with an emphasis on pre-treatment physical state. A discussion will follow, with the audience invited to offer their opinions about these three cases, as well as comments about any similar cases they may have been involved with or have experience of.
Results: The literature shows that an adverse medical history is the factor most commonly associated with a fatal outcome. In general those factors which contribute to significant anaesthetic risk also contribute to risk with ECT. All three patients in these cases were severely physically ill and nursed in an acute medical ward prior to ECT being commenced. In all cases it was agreed that the patients would die from their medical condition if their depression was not treated. All were assessed as a high anaesthetic risk prior to ECT being given. All were returned to the acute medical ward for intensive nursing care following the ECT session. In all, the ECT session itself was uneventful. The single treatment of ECT precipitated an acute decline in physical state over the following 24 hours, with death occurring 3 to 7 days later. None of the patients recovered well enough to receive a second ECT treatment.