Comparative lower limb hemodynamics using neuromuscular electrical stimulation (NMES) versus intermittent pneumatic compression (IPC)

Abstract

Deep Vein Thrombosis (DVT) is a life threatening condition and a serious concern among hospitalised patients, with death occurring in approximately 6% of cases. Intermittent pneumatic compression (IPC) is commonly used for DVT prevention, however suffers from low compliance and issues of usability and portability. Neuromuscular electrical stimulation (NMES) has been shown to improve lower limb hemodynamics but direct comparison with IPC in terms of hemodynamics is rare but very important to determine the potential effectiveness of NMES in DVT prevention.Lower limb IPC was compared to calf NMES, in 30 healthy volunteers (18-23 years). Each intervention was carried out on each leg, on the popliteal vein measured using Doppler ultrasound. All interventions produced significantly greater haemodynamic responses compared to baseline. Calf-IPC and NMES produced significant increases in venous blood velocity (cm/s) and volume of blood ejected per cycle (1 cycle of NMES expels 23.22 ml compared to the baseline ejected volume of 2.52 ml, measured over 1 s (p < 0.001 versues baseline).Improving lower limb hemodynamics is vital in preventing DVT. NMES resulted in larger ejected volumes compared to IPC (x3 greater than foot-IPC and x1.7 greater than calf-IPC) more effectively emptying the veins and soleal sinuses. This is an important finding as DVT occurs predominantly in the soleal sinuses. NMES is silent and portable and thus does not suffer many of the issues associated with IPC. This work supports the potential widespread application of NMES in hospital and home settings where the risk of DVT formation is high.

Hemodynamics and tolerability of lower-limb intermittent pneumatic compression devices and neuromuscular stimulation

“…The finding that foot‐IPC exhibited the lowest hemodynamic responses would seem to suggest that this is the least effective therapeutic modality for DVT prevention. Our results are supported by other hemodynamic studies . Clinically, however, there are very few direct randomized comparative studies that analyze the rate of DVT as primary outcome and those which exist fail to detect significant differences in DVT prevention .…”

“…The two adhesive 5 × 5 cm skin electrodes (Dura‐Stick ® Plus) were attached to the back of the calf. The chosen position was the middle‐lower part of the two heads of the gastrocnemious for the upper electrode and the middle part of soleus muscle just below the gastrocnemious for the lower patch, where the most common site of DVT, the soleal sinuses, exist. This placement was chosen with the help of ultrasound, as it was the position which produced the maximum rise in the blood flow in the popliteal vein for a given stimulus.…”

“…Recent studies showed that the peak venous velocity (PV) at baseline is around 11 cm/s and after applying foot‐IPC the PV rises up to 50 cm/s with a maximum standard deviation of 15 . Thus, three patients per group would be required to detect a difference of 39 cm/s in PV (two‐sided type‐I error rate = 5%; power = 80%).…”

Effects of intermittent pneumatic compression vs. neuromuscular electrical stimulation on recovery following anaerobic exercise in male basketball players

“…When we compared the no treatment group, NMES was found to be better than IPC in enhancing recovery and performance, this may happen due its analgesic effects on muscle soreness [23], neuro-mediator release like IJBAR (2016) 07 (10) www.ssjournals.com endorphin that may induce transient analgesia [55] and its role on post exercise muscle metabolite removal, secondary to increased blood flow and lymphatic drainage to the stimulated area [24]. These NMES group findings are supporting the previous finding of one recent study on comparison of NMES vs. IPC on lower limb hemodynamics in DVT patients [56]. So, we can conclude from the result NMES is better mode of recovery as compared to IPC and passive rest.…”

Hemodynamic effects of electrical muscle stimulation in the prophylaxis of deep vein thrombosis for intensive care unit patients: a randomized trial

“…It has been thought that EMS activates muscle pumping by contracting the lower extremity skeletal muscles and thus produces more physiological hemodynamic forces than IPC or compression stocking [16, 17]. From this point of view, one report compared EMS with IPC in terms of the influences of lower limb hemodynamics and showed that EMS led to more effective ejection of blood in conditions of venous stasis of the lower limbs [18]. It was shown that EMS had a potential for greater hemodynamic effect on the lower extremities than that of IPC.…”