External CounterPulsation - Information

External CounterPulsation – Information

External Counterpulsation (ECP) is a non-invasive circulatory assist therapy somewhat similar to Intra Aortic Balloon Pump (IABP) and is administered on an outpatient basis.However in ECP a substantially large volume of blood is returned to the heart as compared to IABP and has to be used in chronic phase.

External Counterpulsation (ECP) decreases cardiac workload while increasing myocardial perfusion pressure and cardiac output. The use of External Counterpulsation (ECP) for the outpatient treatment of Coronary Artery Diseases(CAD) and Congestive Heart Failure (CHF) reduces the frequency of Angina (chest pain episodes), increase exercise tolerance, reduce the intake of medications.Results of clinical trials show that ECP is a safe and effective choice for people who are considered at high risk for bypass surgery and angioplasty. The procedure is administered in an outpatient setting, does not require any surgery or anaesthetic, and is relatively comfortable both physically and economically for patients.

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External CounterPulsation – The Procedure

External CounterPulsation (ECP) sequentially compresses the legs from the calves, thighs, buttocks and upper arms, by inflating four sets of foam padded fabric cuffs during diastole.

This results in the movement of blood from the legs to the heart and entire upper body.Pressure, up to the range of 300 mmHg, is applied with the timing and duration of each pulse synchronized with the patient's ECG. When triggered, the pressure pulses applied to the legs and buttocks transmit retrograde pressure through the entire vascular system, raising diastolic aortic pressure and increasing coronary perfusion pressure. The compression of the vascular beds in the legs, buttocks and arms also increases venous return increasing cardiac output.

This procedure is carried out in 35 sessions of 1 hour each at a frequency of six days a week, and usually takes 40 days to complete. This is the minimum time protocol to be observed by the External CounterPulsation (ECP) therapist, some patients may require more sittings to maximise their benefits from External CounterPulsation (ECP). The extra numbers of sittings required are decided by the physician depending on the patient’s state.

External CounterPulsation – The Benefits

External CounterPulsation (ECP) appears to have both short-term and long-term benefits. A study published in the Clinical Cardiology reported results in 33 patients with coronary heart disease who received External CounterPulsation (ECP).

After five years, 64 percent did not need bypass surgery or balloon angioplasty and did not have a major adverse cardiovascular event. This rate is similar to that found in many people who are treated with bypass surgery or angioplasty. A more recent study showed that External CounterPulsation (ECP) procedure relieves angina and improves perfusion (blood flow to the heart) during stress in patients with coronary artery disease. The research was published in the April 1, 2002 issue of the American Journal of Cardiology. Doctors are uncertain exactly how External CounterPulsation (ECP) helps ease angina. The procedure may stimulate the growth of tiny blood vessels in the heart and help bypass blocked blood vessels. This would increase blood flow and oxygen to deprived areas of the heart. External CounterPulsation (ECP) may also improve the function of existing blood vessels.

External CounterPulsation (ECP) unequivocally and significantly increases diastolic and mean pressures and reduces systolic pressure in the central aorta and coronary artery. Coronary artery flow, determined by both Doppler and angiographic techniques, is increased during External CounterPulsation (ECP). The combined effects of systolic unloading and increased coronary perfusion pressure provide evidence that External CounterPulsation (ECP) may serve as a potential mechanical assist device.

Summary of Effects of External CounterPulsation

Biochemical Markers
• Increase in Nitric Oxide Levels
• Decrease in Endothelin Levels
• Decrease in BNP Levels
• Increase in VEGF Levels

Functional Measures
• Increase in Time to ST Depression
• Increase in Exercise Tolerance
• Improvement in Peak Oxygen Consumption
• Increase in Cardiac Contractility
• Reduction in Systemic Vascular Resistance
• Decrease in Peak Systolic Pressure
• Increase in Ejection Fraction
• Increase in Cardiac Output
• Increase in Intra coronary Pressure and Blood Flow Velocity

Clinical Outcomes
• Increase in Nitric Oxide Levels
• Decrease in Endothelin Levels
• Decrease in BNP Levels
Increase in VEGF Levels

External CounterPulsation – Indications and Contraindications

External CounterPulsation (ECP) therapy is a safe and effective treatment that provides sustained duration of benefit in patients with disabling angina and angina equivalents, left ventricular dysfunction (LVD), and heart failure. IECP therapy is indicated for use in stable and unstable angina pectoris, congestive heart failure, acute myocardial infarction, and cardiogenic shock.

Patients who can be benefited with External CounterPulsation (ECP)

Patients with angina or angina equivalents who:
• No longer respond to medical therapy.
• Restrict their activities to avoid angina symptoms.
• Are unwilling to undergo any additional invasive revascularization procedures.
• Have LVD (EF<35%).
• Have co-morbid conditions that increase the risk of revascularization procedures (e.g., diabetes, Heart failure, pulmonary disease and renal dysfunction).
• Have coronary anatomy unsuitable for surgical or catheter-based revascularization.
• Are considered inoperable or at high risk of operative/interventional complications.
• Suffer with micro vascular angina (Cardiac Syndrome X).

Heart failure patients in a euvolemic state with:
• Ischemic or idiopathic cardiomyopathy.
• LVD (EF<35%)
• Co-morbid conditions that increase the risk of complications of revascularization procedures.

External CounterPulsation (ECP) however may sadly not be suitably administered to every patient as there are contraindications please click here to know more.

External CounterPulsation – The IECP equipment.

External CounterPulsation – IECP model SL-100 system

The IECP Increased External CounterPulsation unit SL-100 from TeraMed is far more technologically advanced system than the legacy ECP units available in the market.

The working principle of this machine is on a unique design, which was designed jointly by team of TeraMed engineers and German engineers. The IECP unit uses the principle of velocity rather than volume. In the technology that uses volume normally the working nozzles are big in size to transfer volume of air from one area to another, as a result the patient is constantly in a position which we call as horse riding in which the patient is jumping throughout the treatment which is not recommended for patients above 55 years of age. There is a requirement of constant monitoring of the time parameter in the diastolic phase and the ecp therapist has to keep adjusting the parameters. The auto functions cannot be accurately adjusted as transfer of air from one area to another is a sluggish environment. The machine is bulky with excessive downtime primarily of moving components.

On the contrary the machine like IECP that is based on the velocity of air is smaller in size, does not have horse riding position, the diastolic phase is more accurately calculated, auto functions work more precisely and there is less of downtime even of the moving components.

Moreover when you buy an ‘IECP’ SL-100 system, you not only buy the mechanical piece of engineering, but also a bouquet of training, support and services from a supplier who is well known in the medical fraternity and have a commendable history of serving the medical fraternity from the last 18 years. At TeraMed people are working 24 X 7 to help ensure the success of your practice and that your patients receive the best possible therapy.

To download Videos, brochures, catalogues and physician guides along with more details and specifications of the IECP SL-100 System, click the downloads link...