Comparison of hands-free Trans-nasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) with conventional facemask ventilation technique for oxygenation in patients undergoing electroconvulsive therapy - A cross over study.

Objectives: Modified ECT is routinely conducted using face mask (FM) and bag ventilation technique. Trans-nasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) is a novel hands-free insufflation technique that provides oxygenation and prolongs apnoea time. There is limited literature comparing the two techniques. Primary objective of this study was to compare oxygen desaturation between THRIVE and FM techniques during ECT while secondary objective was to compare hemodynamics and complications.

Methods: Patients aged 18-50 years undergoing 3rd-5th ECT treatments were enrolled. First ECT was with FM technique followed by THRIVE (with LUBO collar) in the next ECT. Except for the oxygenation technique, the protocol for ECT administration was similar with both techniques. SpO values were recorded every minute for 10 min while hemodynamic parameters were measured at 2 min and 5 min following administration of electrical stimulus. Any drop in SpO below 92 % was considered as a desaturation event.

Results: A total of 201 patients underwent ECTs, one each with FM and THRIVE technique. Median age of patients was 28 years. There was no difference in SpO between the techniques (main effect P = 0.324, interaction P = 0.14). Only one patient had desaturation with THRIVE requiring intervention with FM. None of the patients had any airway complications in terms of nasal injury, hoarseness, or pneumothorax with THRIVE.

Conclusion: THRIVE is a safe alternative option for hands-free oxygenation while administering ECT. However, considering patient safety, an anaesthesiologist competent in airway management must be readily available.