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
ARTICLE HIGHLIGHTS
Research 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). Early mobilization in the ICU after cardiac surgery is associated with a reduced duration of mechanical ventilation and ICU length of stay.

Research motivation

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.

Research objectives

To evaluate safety, feasibility and effectiveness of NMES on functional capacity and muscle strength in patients before and after cardiac surgery.

Research methods

We performed a search on Pubmed, 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 Physiotherapy Evidence Database. The primary outcomes were safety and functional capacity and the secondary outcomes were muscle strength and function.

Research 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.

Research conclusions

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.

Research perspectives

The present systematic review evaluated the beneficial effects of NMES on functional capacity, muscle strength and muscle function. NMES should be initiated in patients as a form of prehabilitation before a major cardiac surgery and be continued immediately after the surgery until hospital discharge. A multidisciplinary team approach is necessary for its implementation. Preventing ICUAW and polyneuromyopathy via NMES could result in better prognosis, reduced length of stay in the ICU, less complications and improved exercise tolerance and mobility of cardiac surgery patients.