Division of Experimental Medicine, McGill University, Montreal, QC, Canada.
Nova Southeastern University, Fort Lauderdale, FL, United States of America.
PLoS One. 2020 Aug 17;15(8):e0237866. doi: 10.1371/journal.pone.0237866. eCollection 2020.
Bedrest and immobilization following a myocardial infarction (MI) can lead to functional impairment that can persist following hospitalization. Early mobilization (EM) is associated with good functional and clinical outcomes in critical care, medical and surgical settings. However, the impact and current role of EM in post-MI care has not been well-defined. Our objective was to assess the evidence for post-MI mobilization, define current post-MI mobilization practice, and understand perspectives of cardiovascular professionals toward mobilization. A scoping review related to "early mobilization" and "myocardial infarction" was performed using the Joanna Briggs Institute Methodology. Pubmed, Embase, Google Scholar, Cochrane Library and CINAHL databases were included. Results were categorized into six topic areas. There were 59 references included in the analysis. There was evidence for the effectiveness and safety of earlier mobilization in experimental studies of the pre-revascularization era, but there was a lack of strong evidence for EM in contemporary post-MI care. Mobilization appears to be safe following arterial catheterization and is associated with minimal hemodynamic and respiratory compromise. Most people are delayed in mobilizing post-MI and spend the majority of the initial hospitalization period lying in bed. Only 1 of 7 current major cardiovascular professional societies guidelines recommend EM post-MI. There were no studies exploring the perspectives of cardiovascular professionals toward mobilization. EM may be beneficial in the post-MI care. However, there is an evidence gap for the impact of EM post-MI in the contemporary literature. More robust evidence from randomized clinical trials is required to inform clinicians and influence practice.
心肌梗死后卧床和固定会导致功能障碍,这种障碍在住院后仍会持续。早期活动(EM)与重症监护、内科和外科环境中的良好功能和临床结局相关。然而,EM 在心肌梗死后护理中的作用和影响尚未得到很好的定义。我们的目的是评估心肌梗死后活动的证据,定义当前心肌梗死后活动的实践,并了解心血管专业人员对活动的看法。使用 Joanna Briggs 研究所方法进行了与“早期活动”和“心肌梗死”相关的范围综述。纳入了 Pubmed、Embase、Google Scholar、Cochrane 图书馆和 CINAHL 数据库。结果分为六个主题领域。分析中包括 59 篇参考文献。在再血管化前时代的实验研究中,早期活动的有效性和安全性有证据支持,但在当代心肌梗死后护理中,EM 的证据不足。在动脉导管插入术后进行活动似乎是安全的,并且与最小的血液动力学和呼吸窘迫相关。大多数人在心肌梗死后活动延迟,并且在初始住院期间大部分时间都躺在床上。只有 7 个当前主要心血管专业协会指南中的 1 个建议在心肌梗死后进行 EM。没有研究探讨心血管专业人员对活动的看法。EM 在心肌梗死后护理中可能有益。然而,在当代文献中,EM 对心肌梗死后的影响存在证据空白。需要来自随机临床试验的更有力证据来为临床医生提供信息并影响实践。