Respiratory complications related to electroconvulsive therapy (ECT) are a rare occurrence. The need for endotracheal intubation during ECT is rarely indicated. We report a case of a 47-year-old woman with severe gastroesophageal reflux disease and depression who was intubated for her first 3 ECT treatments. She developed a small tracheal tear after her third ECT treatment which resulted in subcutaneous emphysema, pneumopericardium, and pneumomediastinum. The tracheal tear resolved spontaneously and ultimately the patient underwent subsequent ECT treatments successfully without intubation. This case is the first reported case of complications related to endotracheal intubation during ECT.