Feasibility of neuromuscular electrical stimulation immediately after cardiovascular surgery

Abstract

Objective: To determine the safety and feasibility of neuromuscular electrical stimulation (NMES) from postoperative days (PODs) 1 to 5 after cardiovascular surgery.

Design: Pre-post interventional study.

Setting: Surgical intensive care unit and thoracic surgical ward of a university hospital.

Participants: Consecutive patients (N=144) who underwent cardiovascular surgery were included. Patients with peripheral arterial disease, psychiatric disease, neuromuscular disease, and dementia were excluded. Patients with severe chronic renal failure and those who required prolonged mechanical ventilation after surgery were also excluded because of the possibility of affecting the outcome of a future controlled study.

Interventions: NMES to the lower extremities was implemented from PODs 1 to 5.

Main outcome measures: Feasibility outcomes included compliance, the number of the patients who had changes in systolic blood pressure (BP) >20 mmHg or an increase in heart rate >20 beats/min during NMES, and the incidence of temporary pacemaker malfunction or postoperative cardiac arrhythmias.

Results: Sixty-eight of 105 eligible patients participated in this study. Sixty-one (89.7%) of them completed NMES sessions. We found no patients who had excessive changes in systolic blood pressure, increased heart rate, or pacemaker malfunction during NMES. Incidence of atrial fibrillation during the study period was 26.9% (7/26) for coronary artery bypass surgery, 18.2% (4/22) for valvular surgery, and 20.0% (4/20) for combined or aortic surgery. No sustained ventricular arrhythmia or ventricular fibrillation was observed.

Conclusions: The results of this study demonstrate that NMES can be safely implemented even in patients immediately after cardiovascular surgery.

Keywords: Arrhythmias, cardiac; Cardiovascular surgical procedures; Electric stimulation therapy; Hemodynamics; Rehabilitation.