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External Counterpulsation (ECP)

Heart and Healthcare Centre

External Counterpulsation (ECP)

ECP is a non-invasive, non-surgical outpatient treatment for patients suffering primarily from coronary artery disease and heart failure. ECP is supported by modern scientific theory and is performed by computer and digital electronic control. The treatment results in the improvement of in the circulation of blood throughout the body and hence treats ischaemic disorders of the various organs (i.e. organs that do not receive sufficient blood supply, e.g. the heart, brain, kidneys etc). Clinical studies over the past several years have shown that most patients treated with a single course of ECP experience a reduction in angina and are able to return to an active lifestyle. 

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Benefits of ECP

ECP stimulates the production of endogenous insulin from the pancreas, hence decreasing blood glucose levels. ECP also stimulates the body’s ability to utilize sugar by the increased blood flow, hence increasing the metabolic and cellular rate. Both of these results in better blood glucose control.  Since insulin levels in the body rise, the need for medicated (exogenous) insulin decreases.

 

Erectile Dysfunction (ED)

Many patients who suffer from both cardiac problems and erectile dysfunction cannot take medications for ED and cardiac problems together due to side effects. Hence, problem persists.
ECP increases blood flow not only to the heart but also to the internal iliac artery by 40% (responsible for supply to gonadal region). Therefore ECP treats ED of vascular origin mainly (i e ED due to impediment of blood supply to the penis). Penile perfusion is increased (increased blood supply to the penis). The subsequent effects is improvement in the quality of the erection. A study in Germany showed that men reported a significant improvement in penile rigidity and erectile function after 20 treatments of ECP.

 

Chronic Fatigue Syndrome

ECP causes increased blood flow to all tissues resulting in increased oxygen delivery and nutrients. This provides more energy for tissues to function and thus more energy to carry out tasks.

 

Quick recoveries from sport injuries

Increased blood flow to damaged muscles, tendons or ligaments allows these structures to heal more rapidly than usual. Toxins and waste products are eliminated and oxygen delivery and nutrients supply is at a greater rate, thus improving recovery.

 

Improvement in sports performance

Increased ability to perform as the increased blood flow increases nutrients and oxygen delivered for muscles to work efficiently. Therefore, muscles work at their optimum level.

History of ECP External Counterpulsation

Kantrowitzs first described the principle “phase shift diastolic augmentation” in 1953. Physicians and physicists at Harvard and elsewhere related this principle to oxygen consumption and cardiac workload. This understanding led to the concept of mechanically induced “cardiac assistance” for patients with low cardiac output syndromes, especially cardiogenic shock.

 

Beginning in the 1960’s, research on mechanically induced “Cardiac assistance” followed two distinct paths; one involved the use of a balloon positioned inside the descending thoracic aorta that would inflate during diastole and deflate at the onset of systole, and another of the vascular beds in the lower limbs. The first came to be known as the intra-aortic balloon pump (IABP). The second evolves as to what is now referred as ECP. These early systems were somewhat primitive by today’s standards. But both forms of counterpulsation clearly demonstrated the potential for increasing survival of patients with myocardial infarction and cardiogenic shock as well as for relief of angina pectoris.

 

In 1960’s Three groups (Birtwell and Soroff, Dennis and Osborn) independently developed hydraulically activated external counter pulsation devices and found the technique effective in improving survival after myocardial infarction complicated by cardiogenic shock. Initial experience with a crude external counterpulsation device used in stable angina saw relief of angina symptoms with angiographic evidence of increased vascularity.

 

Early hydraulic systems for ECP eventually gave way to pneumatics. This along with refinements of the compression element of the system, helped to improve outcomes and patient comfort. The national institutes of health (NIH) in the USA played a significant role in the evolution of the modern ECP systems by advocating the additional of a second cuff and the use of a sequential cuff inflation to increase the amount of blood being returned to the heart and as a results diastolic augmentation.

 

Before 1970’s all ECP’s were “non-sequenced” pulsation. During the 1970’s, Zheng and Associates at Sun yat Sen University in China reported on a newly designed 3-stage pneumatic pulsation system. In this trial the effect of sequenced cuff inflation were studied in patients with angina, the system provided long-term symptomatic relief with minimal relapse, following 36 hours of treatment. Their clinical experience led to the installation of more than 1,500 external counterpulsation units in China during the past 15 years leading to the development and refinement of the EECP technique and device.