Electrostimulation for the prevention of deep venous thrombosis in patients with major trauma: a prospective randomized study.
BACKGROUND
Current methods of posttraumatic thromboprophylaxis (heparins and sequential compression devices) are inadequate. New methods should be tested. Muscle electrostimulation (MEST) has been used over the years with mixed-but predominantly encouraging-results for a variety of conditions, including prevention of deep venous thrombosis (DVT). It has not been tested in multiple trauma patients.


METHODS
Trauma patients with Injury Severity Score higher than 9 who were admitted to the intensive care unit and had a contraindication for prophylactic heparinization were randomized to groups MEST and control. MEST patients received 30-minute MEST sessions twice daily for 7 to 14 days. Venous flow velocity and venous diameter were measured by duplex venous scan. Venography-or, if not available, duplex-was used to evaluate the presence of proximal and peripheral DVT between days 7 and 15.


RESULTS
After exclusions, 26 MEST and 21 control patients completed the study and received outcome evaluation by venography (25) or duplex (22). Three patients in each group developed proximal DVT (11.5% vs 14%, P = .79), and an additional 4 (15%) MEST group and 3 (14%) control group patients developed peripheral DVT ( P = .96). There was no difference in venous flow velocity or venous diameter between the groups.


CONCLUSIONS
MEST was not effective in decreasing DVT rates in major trauma patients.
Velmahos
George C
GC
Department of Surgery, Division of Trauma and Critical Care, Los Angeles County and University of Southern California Medical Center, USA. gvelmahos@partners.org
Petrone
Patrizio
P
Chan
Linda S
LS
Hanks
Sue Ellen
SE
Brown
Carlos V
CV
Demetriades
Demetrios
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007866:Leg / Q000098:blood supply / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal; D011446:Prospective Studies; D011859:Radiography; D017211:Treatment Failure; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000150:complications*