(607) Neuromuscular Electrical Stimulation for Venous Thromboembolism Prevention in Neurocritical Care

Introduction: Venous thromboembolism (VTE) is common in neurocritical care (NCC) patients, due to prolonged immobilization, hospitalization and delay in pharmacologic VTE prophylaxis initiation. Mechanical VTE prophylaxis using sequential compression devices (SCD) is standard of care, however these have been associated with increased falls, skin breakdown, and poor adherence, reported ranging 40-60%. There is a need for well tolerated and effective methods to prevent VTE in this population. Direct neuromuscular electrical stimulation of the common peroneal nerve using a wearable stimulator (Geko; Firstkind Ltd) has been shown to improve venous blood flow and reduce VTE incidence in other patient populations.

Methods: In this single-center observational retrospective study, we report the feasibility of Geko usage and deep vein thrombosis (DVT) incidence in a small cohort of NCC patients. An unpaired 2-tailed T-test was used to compare groups.

Results: 34 patients were included. Geko was applied consistently to 12/34 (35.2%) patients. Of these, 5/12 (41.6%) had a venous duplex ultrasound study (VDUS) on day of Geko initiation, and 1/5 (20%) had a DVT. By one week, 6/12 (50%) had a VDUS, and 1/6 (16.7%) patients had a DVT. Geko use was inconsistent and alternated with SCDs in 21/34 (61.8%) patients. In this group, 9/21 (42.3%) patients had a VDUS upon Geko initiation, and DVT was diagnosed in 1/21 (4.8%) patients. By one week, 11/21 (52.3%) patients had a VDUS, and 6/11 (54.5%) patients had a DVT. DVT incidence was significantly lower in the Geko usage group (p < 0.001). 4/21 patients in the Geko-SCD group and none in the Geko group had enoxaparin initiated during their period of Geko usage. 1/34 (2.9%) patients in the cohort requested Geko removal due to discomfort. Mortality in the Geko group was 1/12 (8.3%) and the Geko-SCD group was 4/21 (19%) at time of discharge.

Conclusions: Use of Geko is feasible, safe and well tolerated in NCC patients. Our small study indicates that Geko when consistently used, Geko may be associated with reduced DVT incidence in this population. n. Additional larger prospective studies are needed to confirm our findings.