Systematic Reviews
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jan 26, 2024; 16(1): 27-39
Published online Jan 26, 2024. doi: 10.4330/wjc.v16.i1.27
Safety and effectiveness of neuromuscular electrical stimulation in cardiac surgery: A systematic review
Christos Kourek, Marios Kanellopoulos, Vasiliki Raidou, Michalis Antonopoulos, Eleftherios Karatzanos, Irini Patsaki, Stavros Dimopoulos
Christos Kourek, Medical School of Athens, National and Kapodistrian University of Athens, Athens 15772, Greece
Marios Kanellopoulos, Vasiliki Raidou, Eleftherios Karatzanos, Stavros Dimopoulos, Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, Evangelismos Hospital, Athens 10676, Greece
Michalis Antonopoulos, Stavros Dimopoulos, Intensive Care Unit, Onassis Cardiac Surgery Center, Kallithea 17674, Greece
Irini Patsaki, Department of Physiotherapy, University of West Attica, Athens 12243, Greece
Co-first authors: Christos Kourek and Marios Kanellopoulos.
Author contributions: Kourek C, Kanellopoulos M and Dimopoulos S conceptualized and designed the research; Kourek C, Kanellopoulos M and Raidou V performed the research; Kourek C, Kanellopoulos M, Raidou V and Dimopoulos S analyzed the data; Kourek C and Kanellopoulos M wrote the paper. All the authors have read and approved the final manuscript. Kourek C and Kanellopoulos M proposed and designed the research, performed data analysis and prepared the first draft of the manuscript. Both authors have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper.
Conflict-of-interest statement: All the authors received no financial support for the research, authorship, and/or publication of this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Stavros Dimopoulos, MD, PhD, Director, Intensive Care Unit, Onassis Cardiac Surgery Center, Kallithea 17674, Greece. stdimop@gmail.com
Received: November 29, 2023
Peer-review started: November 29, 2023
First decision: December 12, 2023
Revised: December 14, 2023
Accepted: January 3, 2024
Article in press: January 3, 2024
Published online: January 26, 2024
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.

Keywords: Neuromuscular electrical stimulation, Cardiac surgery, coronary artery bypass grafting, Heart valve replacement, Peak VO2, Safety

Core Tip: Data regarding the effects of neuromuscular electrical stimulation (NMES) in cardiac surgery patients still remains limited. We investigated the safety and the effectiveness of NMES on functional capacity and muscle strength and function in patients before and after cardiac surgery. We observed that NMES has beneficial effects on muscle strength and function, but its effect on functional capacity is not clear. Moreover, NMES is safe and feasible for cardiac surgery patients without any major adverse events.