To evaluate the safety of needle Electromyography (EMG) in patients who are critically ill and in the Intensive Care Unit (ICU).

Needle EMG is a relatively safe procedure, and in most cases, the yield of the study outweighs the risks associated with it. However, the safety of needle EMG in critically ill ICU patients and with multiple medical co-morbidities remain unknown. 

Retrospective chart review of the patients who were in the ICU and those who underwent a needle EMG were followed up for 2 weeks post procedure (2014-2017). Basic demographics, indication for the study, presence of sepsis, coagulation studies, use of anticoagulants, thrombocytopenia, and hepatic functions were reviewed. Complications including acute bleeding at the site of procedure, hematoma requiring clinical intervention, infection attributed to EMG were reviewed. 

30 patients were included - mean age was 58 +/- 16.7 years. 17 (57%) were males. Elevated PT was seen in 7 (23%), PTT in 5 (16%). Thrombocytopenia was seen in 7 (23%), liver function tests were abnormal in 8 (27%). Low molecular weight heparin was used in 14 (47%), SC heparin in 9 (30%) for DVT prophylaxis.  3 (10%) had sepsis, and 8 (26%) had a diagnosis of cancer. 23 patients had more than two co-morbid conditions that increased the risk of bleeding. The most common indications for EMG study were critical ill neuropathy in 19 (63%), myopathy in 4 (13%), motor neuron disease in 4 (13%), radiculopathy in 3(10%), and neuromuscular junction disorders in 2 (6%) patients. Total of 190 muscles was tested, 38 (20%) were deep muscles. No complications were reported during and 2 weeks post procedure including those with two or more co-morbid conditions that increase the risk of bleeding or infection.

Needle EMG of both superficial and deep muscles is safe in critically ill patients even with multiple comorbidities.