JECT-12-105
Appendix 1
CANECTS/ECANEC
Canadian National ECT Survey/ Enquête CANadienne sur les Electrochocs
Section 5: ECT APPARATUS
5.1 Which ECT device is most commonly used at your site? (check one only)
Ectron Duopulse Mark 4
MECTA JR1 or JR2
MECTA SR1 or SR2
MECTA spECTrum 4000M
MECTA spECTrum 4000Q
MECTA spECTrum 5000M
MECTA spECTrum 5000Q
Medcraft Hittman B24 III ECT
Siemens Konvulsator
Thymatron Model I (Somatics)
Thymatron DG
Thymatron DGX
Thymatron System IV
Other (specify make and model): ___________________________________________________
5.2 How frequently does your institution use a sine or partial sine wave electrical stimulus for ECT?
(Check one only)
Never Occasionally* Routinely*
*If sine wave stimulation is provided, specify the make and model of the device: ________________
5.3 In the event of ECT device failure, do you have a back-up device available? (Check all that apply)
No back-up available
On loan arrangement
Own a back-up device
Other (specify arrangement):
If back-up device is available, specify make and model:
Ectron Duopulse Mark 4
MECTA JR1 or JR2
MECTA SR1 or SR2
MECTA spECTrum 4000M
MECTA spECTrum 4000Q
MECTA spECTrum 5000M
MECTA spECTrum 5000Q
Medcraft Hittman B24 III ECT
Siemens Konvulsator
Thymatron Model I (Somatics)
Thymatron DG
Thymatron DGX
Thymatron System IV
Other (specify make and model): _______________________________________________
5.4 Is your ECT equipment regularly serviced?
No
Yes If “yes,” specify how often: ________________________________________________Yearly
Less frequently than yearly
More frequently than yearly
Uncertain
5.5 Please rate the quality of the technical support (if known) you receive at your facility for your
ECT equipment (including timeliness, reliability, helpfulness of biomedical engineers and
technicians, etc.):
Excellent Good Fair Poor
Section 6: ECT STIMULUS
6.1 Who most frequently administers the ECT stimulus (that is, selects the stimulus parameters and
activates the stimulus) at your facility? (check one only)
Psychiatrist
Psychiatry resident with direct supervision by a psychiatrist
Psychiatry resident alone
General physician or family physician
Anesthesiologist
Internal medicine specialist
Nurse practitioner
Other (specify): ______________________________________________________________
6.2 In the reporting period, were clinicians other than the one specified above (in question 6.1) ever
involved in the administration of the ECT electrical stimulus (that is, selecting the stimulus
parameters and activating the stimulus)?
Yes No
If “yes,” check all that apply:
Psychiatrist
Psychiatry resident with direct supervision by a psychiatrist
Psychiatry resident alone
General physician or family physician
Anesthesiologist
Internal medicine specialist
Nurse practitioner
Other (specify):
_________________________________________________________________
6.3 During the reporting period, how many doctors (or other personnel) were involved in
administering ECT? (please provide estimated number or range):
Doctors (or other personnel) providing anesthesia:_______________
Doctors (or other personnel) administering the electrical stimulus:____________
6.4 Does your facility grant specific privileges for the clinician administering the ECT electrical
stimulus?
Yes No
If “yes,” indicate which of the following apply to your facility: (check all that apply)
Facility has informal (general) criteria for granting ECT privileges
Facility has formal written criteria for granting ECT privileges
Facility has informal (general) criteria for maintaining ECT privileges
Facility has formal written criteria for maintaining ECT privileges
Facility has continuing medical education requirements for clinicians involved in the
administration of ECT
6.5 Prior to the attachment of the stimulus electrodes, the following procedures are used (check all
that apply):
No special measures are taken
The skin is cleaned with alcohol
The skin is cleaned with acetone
Electrode jelly is rubbed into the skin
The skin is lightly abraded with electrode paste
Electrode jelly is applied to the electrodes
A solution for adhesive stimulus electrodes (e.g., Thymatron pads) is applied
Other (specify):____________________________________________________
6.6 Please rank order the following ECT electrode placements from “1” (most common) to “4”
(least common) to indicate their frequency of use at your institution: (please rank only those
placements that are actually used at your site)
Bilateral (bitemporal or any other bilateral placement that is not specifically bifrontal)
Bifrontal
Right unilateral (d’Elia)
Other (specify with rationale): _______________________________________________
6.7 If applicable, how is the intensity of the initial stimulus usually chosen for bilateral
(bitemporal) ECT at your facility? This question pertains to bilateral placements that are not
specifically bifrontal. (check one only)
Not applicable – bilateral (bitemporal) ECT is not provided
Fixed charge, energy, or percentage (please answer follow-up question)
Titration-based measurement of seizure threshold (please answer follow-up question)
Stimulus dose based on age
Stimulus dose based on half-age
Algorithm based on age and gender
No systematic approach
Other approach (specify): ______________________
If a fixed dose is used, specify the initial stimulus intensity used:___________________
If titration-based measurement of seizure threshold is used, specify the formula used to select the
stimulus intensity for subsequent treatments (e.g., 1.5 X seizure threshold, 2.5 X threshold, 6 X
threshold, etc.):_________________
6.8 If applicable, how is the intensity of the initial stimulus usually chosen for bifrontal ECT at
your facility? (check one only)
Not applicable – bilateral (bifrontal) ECT is not provided
Fixed charge, energy, or percentage (please answer follow-up question)
Titration-based measurement of seizure threshold (please answer follow-up question)
Stimulus dose based on age
Stimulus dose based on half-age
Algorithm based on age and gender
No systematic approach
Other approach (specify): ____________________
If a fixed dose is used, specify the initial stimulus intensity used:_____________________
If titration-based measurement of seizure threshold is used, specify the formula used to select the
stimulus intensity for subsequent treatments (e.g., 1.5 X seizure threshold, 2.5 X threshold, 6 X
threshold, etc.):______________
6.9 If applicable, how is the intensity of the initial stimulus usually chosen for unilateral ECT at
your facility? (check one only)
Not applicable – unilateral ECT is not provided
Fixed charge, energy, or percentage (please answer follow-up question)
Titration-based measurement of seizure threshold (please answer follow-up question)
Stimulus dose based on age
Stimulus dose based on half-age
Algorithm based on age and gender
No systematic approach
Other approach (specify): ______________________
If a fixed dose is used, specify the initial stimulus intensity used:___________________
If titration-based measurement of seizure threshold is used, specify the formula used to select the
stimulus intensity for subsequent treatments (e.g., 1.5 X seizure threshold, 2.5 X threshold, 6 X
threshold, etc.):_________________
6.10 Which of the following methods are routinely used to monitor the elicited seizure during ECT?
(check all that apply)
Motor seizure duration
Motor seizure duration in a cuffed limb
EMG (electromyogram)
EEG (electroencephalogram) seizure duration
EEG seizure quality (e.g., symmetry, amplitude, regularity, post-ictal suppression)
Cardiovascular response (e.g., duration of tachycardia)
No seizure monitoring is used
6.11 At your institution, the timing of delivery of the ECT stimulus (check all that apply):
Is most often decided by the administrator of the electrical stimulus
Is most often decided by the individual providing anesthesia
Is most often given (insert number)___________ seconds after anesthetic induction drug
administration
Is most often given (insert number)___________ seconds after the neuromuscular blocking
agent
Is sometimes adjusted based on previous patient response
Is decided only after testing with a peripheral nerve stimulator
Other (specify):_______________________________________________
6.12 If the ECT electrical stimulus results in no seizure activity, what procedure is usually followed
at your facility? (check one only)
No specified procedure
Immediately re-stimulate at the same stimulus intensity
Immediately re-stimulate at a higher stimulus intensity
Use a higher stimulus setting at the next treatment session
6.13 If the ECT electrical stimulus results in a seizure that is judged to be inadequate, what
procedure is usually followed at your facility? (check one only)
No specified procedure
Immediately re-stimulate at the same stimulus intensity
Immediately re-stimulate at higher stimulus intensity
Use a higher stimulus setting at the next treatment session
6.14 During the reporting period, what is the maximum number of electrical stimuli used to elicit a
seizure during a single ECT
session? (check one only)
One
Two
Three
Five or more
6.15 Does your facility ever aim to achieve more than one adequate seizure in a single treatment
session?
Yes No