Abstract / Summary
Background: Anesthetic augmentation with aminophylline and/or remifentanil is commonly used to prolong seizure duration when propofol-based electroconvulsive therapy (ECT) results in inadequate seizures. We aimed to identify independent predictors of subsequent augmentation use and develop an exploratory risk score.Methods: This retrospective cohort study (January–December 2015, single center) included 527 patients (4,016 ECT sessions) who received propofol anesthesia. Patients were categorized as propofol-only (n=357) or augmentation (n=170) group. Multiple logistic regression was used to identify predictors of augmentation. ANCOVA compared the effect of different adjunctive agents on post-adjunct seizure duration.Results: Shorter first-session electroencephalography (EEG) seizure duration (OR = 0.968, P < .001) and higher first-session seizure-inducing energy (OR = 1.044, P < .001) independently predicted augmentation, while age was not significant (P = .120). All three augmentation strategies significantly prolonged seizure duration; although, the sample sizes for individual agents (aminophylline n=85, remifentanil n=44, combination n=41) precluded a definitive comparative analysis; the ANCOVA revealed no significant differences between agents (F=0.967, P = .382). CGI scores were comparable between groups at baseline (P = .412) and discharge (P = .321). An exploratory risk score based on the two significant predictors showed good discriminative ability (AUC = 0.786).Conclusion: First-session EEG seizure duration and stimulation energy are practical predictors of subsequent augmentation use, whereas age is not independently predictive. No statistically significant difference in post-adjunct seizure duration was detected among the three adjunctive strategies and augmentation is associated with comparable clinical improvement. External validation of the proposed risk score is required before clinical implementation.