Name of the Procedure:

External counterpulsation (ECP)

• Common Names: ECP
• Technical/Medical Term: Enhanced External Counterpulsation (EECP)

Summary

External counterpulsation is a non-invasive treatment for angina and other conditions where enhanced blood flow is needed. The procedure involves the use of cuffs on the legs that inflate and deflate in sync with the cardiac cycle to improve blood circulation.

Purpose

The purpose of external counterpulsation is to:

• Increase blood flow to the heart
• Reduce symptoms of angina
• Improve exercise tolerance
• Potentially reduce the need for medication or invasive procedures

Indications

• Chronic stable angina that has not responded to other treatments
• Heart failure
• Patients who are not suitable candidates for invasive procedures such as angioplasty or bypass surgery

Preparation

• Patients may be advised to wear comfortable clothing
• Eating a light meal before the procedure is usually permitted
• Patients should inform their doctor about any medications they are taking
• Some diagnostic tests such as an EKG, stress test, or echocardiogram may be required before starting treatment

Procedure Description

1. Patient lies down on a comfortable table.
2. Cuffs are placed around the legs and buttocks.
3. Cuffs inflate and deflate in sync with the patient's heartbeat, guided by an EKG.
4. The inflation and deflation create a pumping action that improves blood flow to the heart.

Tools and Equipment:

• Inflatable cuffs
• EKG machine to monitor the heart's cycle
• External counterpulsation machine to control the inflation/deflation

Anesthesia/Sedation:

• None required

Duration

• Each treatment session lasts about 1 hour.
• Usually, sessions are conducted 5 days a week for a total of 35 sessions over 7 weeks.

Setting

• Outpatient clinic or specialized treatment centers

Personnel

• Cardiologist or specialized ECP technician
• Nursing staff

Risks and Complications

Common Risks:

• Bruising or skin irritation at the cuff sites

Rare Risks:

• Leg pain or discomfort
• Risk of blood clots or worsening of heart failure symptoms (very rare and typically pre-screened)

Benefits

• Relief from chest pain (angina)
• Improved exercise capacity
• Enhanced quality of life
• Benefits can often be seen after a few weeks of treatment

Recovery

• No significant recovery time is needed; patients can typically resume normal activities immediately
• Follow any specific post-procedure instructions from the healthcare provider
• Attend all follow-up appointments for monitoring and assessment of progress

Alternatives

• Medications such as nitrates, beta-blockers, or calcium channel blockers
• Invasive procedures like angioplasty or coronary artery bypass grafting (CABG)
• Lifestyle changes such as diet and exercise

Pros of ECP:

• Non-invasive
• No recovery time

Cons of Alternatives:

• Medications may have side effects
• Invasive procedures carry higher risks and longer recovery times

Patient Experience

During Procedure:

• Patients might feel mild squeezing from the cuffs but no significant pain
• Some patients find the rhythmic sensation relaxing

After Procedure:

• Some patients may feel tired or light-headed immediately after a session
• Any discomfort usually diminishes after the first few sessions

Pain Management and Comfort Measures:

• Mild discomfort can be managed with over-the-counter pain relief if necessary
• Ensuring proper fit of cuffs can enhance comfort