Sudden Death After Electroconvulsive Therapy In The Context Of Coronavirus Disease 2019

Electroconvulsive therapy (ECT) has been demonstrated to be a safe and effective treatment modality for a range of psychiatric illnesses. It is shown to be useful in the management of psychotic disorders for decades, more so in the treatment of refractory schizophrenia when given with antipsychotic medications. We highlight a case of a 37-year-old lady who was on treatment for refractory schizophrenia for the past 10 years but had continued to exhibit residual psychotic symptoms of auditory hallucinations and persecutory delusions that resulted in numerous in-patient admissions. She was initiated on ECT but contracted the coronavirus disease 2019 (COVID-19) before she could receive her second session. After isolating for 2 weeks in a COVID-19-designated isolation ward and testing negative twice, she was rescheduled to continue with her ECT. Ten minutes after leaving theater upon successfully undergoing her second ECT session, she collapsed suddenly and died. An autopsy done later revealed pulmonary thromboembolism as the cause of death. Conclusions Although ECT is a safe procedure, caution should be exercised in the context of COVID-19, as it is now clear that patients who recovered from COVID-19 might have an undetected venous thromboembolism that can cause untoward outcomes. Ethical Consideration A written consent was obtained from the sister to the deceased patient.