Safety and effectiveness of neuromuscular electrical stimulation in cardiac surgery: A systematic review

Abstract

BACKGROUND Lack of mobilization and prolonged stay in the intensive care unit (ICU) are major factors resulting in the development of ICU-acquired muscle weakness (ICUAW). ICUAW is a type of skeletal muscle dysfunction and a common complication of patients after cardiac surgery, and may be a risk factor for prolonged duration of mechanical ventilation, associated with a higher risk of readmission and higher mortality. Early mobilization in the ICU after cardiac surgery has been found to be low with a significant trend to increase over ICU stay and is also associated with a reduced duration of mechanical ventilation and ICU length of stay. Neuromuscular electrical stimulation (NMES) is an alternative modality of exercise in patients with muscle weakness. A major advantage of NMES is that it can be applied even in sedated patients in the ICU, a fact that might enhance early mobilization in these patients. AIM To evaluate safety, feasibility and effectiveness of NMES on functional capacity and muscle strength in patients before and after cardiac surgery. METHODS We performed a search on Pubmed, Physiotherapy Evidence Database (PEDro), Embase and CINAHL databases, selecting papers published between December 2012 and April 2023 and identified published randomized controlled trials (RCTs) that included implementation of NMES in patients before after cardiac surgery. RCTs were assessed for methodological rigor and risk of bias via the PEDro. The primary outcomes were safety and functional capacity and the secondary outcomes were muscle strength and function. RESULTS Ten studies were included in our systematic review, resulting in 703 participants. Almost half of them performed NMES and the other half were included in the control group, treated with usual care. Nine studies investigated patients after cardiac surgery and 1 study before cardiac surgery. Functional capacity was assessed in 8 studies via 6MWT or other indices, and improved only in 1 study before and in 1 after cardiac surgery. Nine studies explored the effects of NMES on muscle strength and function and, most of them, found increase of muscle strength and improvement in muscle function after NMES. NMES was safe in all studies without any significant complication. CONCLUSION NMES is safe, feasible and has beneficial effects on muscle strength and function in patients after cardiac surgery, but has no significant effect on functional capacity.

Safety and Feasibility of Neuromuscular Electrical Stimulation in Patients with Extracorporeal Membrane Oxygenation

“…NMES is an exercise modality that can be applied even in sedated critically ill patients [9]. A NMES prescription includes the NMES frequency in Hz, which is the number of pulses in one second (20-50 pulses per second); the pulse duration in microseconds (for small muscles, approximately 150-200, and for large muscles, 200-300); the ramp time, which is at least 2 sec; the exercise/recovery time ratio, which should be set to allow enough time for muscle recovery from exercise; the treatment session duration, which should be at least 20 to 30 min; and the frequency of sessions, which should occur at least three times per week when applied systemically for a patient [1,20].…”

“…Major implications of ICUAW in ECMO patients include higher percentages of infection during ECMO support, liver and kidney dysfunction, prolonged hospital stay with greater financial burden, increased morbidity and mortality, and reduced quality of life [8]. In a recent systematic review, NMES was shown to be safe and feasible, and has beneficial effects on muscle strength and function in patients after cardiac surgery [9].…”