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How ECP is applied

Pressure up to 310mmHg can be applied depending on patient comfort, with the timing and duration of each pulse, synchronized with the patient’s ECG. When properly triggered the pressure pulses the legs and the buttocks and transmits retrograde flow pressure through the entire vascular system. ECP provides assistance to the heart and other muscle or tissue by diastolic augmentation.

ECP provides diastolic augmentation during diastole by sequentially inflating cuffs positioned on the patients calves, thigh and buttocks.

Cardiac efficiency may be improved by counterpulsation due to the pressure drop during systole. Peripheral perfusion may also be enhanced by the rise in mean systemic perfusion pressure. Near the end of diastole when the ventricles contract in systole, ECP deflates the cuffs causing a reduction in intra-aortic volume and pressure.

80-90% of oxygen is required by the heart when the heart is pumping, counterpulsation may also be effective in reducing the heart’s oxygen requirements.

Indications for use

ECP is used to, and cleared by FDA for increase perfusion during diastole in persons with:

• Chronic Angina Pectoris
• Myocardial Infarction
• Cardiogenic Shock
• Congestive Heart Failure

There is extensive clinical experience showing improvements in patients suffering with these indications. Patients frequently exhibit a decrease in symptoms

Contraindications

• Cardiac catheterization within one to two weeks to minimize the likelihood of bleeding at the femoral puncture site.
• Arrhythmia that might interfere with the triggering of the ECP treatment system such as atrial fibrillation, atrial flutter, ventricular tachycardia.
• Uncontrolled congestive heart failure. In some patients, left ventricular unloading may be insufficient to compensate for increased venous return during ECP treatment.
• Aortic insufficiency where regurgitation would prevent diastolic augmentation.
• Limiting peripheral vascular disease (PVD) and/or phlebitis because of increased risk of thromboembolus. Severe PVD with reduced vascular volume and diminished musculature of the lower extremities can compromise effective counterpulsation.
  
• Severe hypertension (>180/110mmhg). Under these circumstances, ECP treatment could produce diastolic blood pressure levels surpassing acceptable limits.
• Bleeding diathesis, Coumadin® (warfarin, Dupont Merck) therapy with PT>15 because the pressure of cuff inflations might cause bleeding in leg muscles.
• Pregnant women and women of childbearing potential who do not employ a reliable contraceptive method to avoid possible danger to fetus

Benefits of use

• Less chest pain (Angina)
• Less Ventricular Fibrillation
• Decrease or elimination in shock symptoms
• Decrease in heart size
• Less progression in cardiac failure
• Afterload reduction
• Increase in quality of life
• Decrease in mortality rates
• Decrease in hospital admissions

ECP Precautions

Before treating the patient with ECP there are some medical precautions and judgments to be considered:

• Peripheral vascular disease
• Deep vein thrombosis
• Aortic regurgitation
• Abdominal aortic aneurysms
• Left or right bundle branch block
• Significant aortic valve disease
• Uncontrolled arrhythmias
• Significant pulmonary disease
• Pacemaker or defibrillators
• There is no data to support pregnancy

ECP Policy and Procedures

ECP is performed by administering 35 One hour treatments, typically one hour per day 5 days a week Monday through Friday for 7 weeks. Inform the patient of the treatment schedule and it is very important to come every day on the exception of illness or family emergencies

Physician must sign a letter of certification before the patient is to start their ECP treatments. (Keep a copy in the patient ECP chart and the original will go to billing in the first week of treatments)

Referrals for ECP

When receiving an outside referral for ECP, physicians typically review the following items in the the patient history:

• Review of the clinical records
• History and physical
• Procedure reports
• Echocardiogram/stress echo
• Medication list
• Review of diuretics: if the patient is scheduled in the morning have them take their medication after treatment or 6 hours before treatment
• Review of Coumadin: precaution if INR > 3.0
• Review of Blood Pressure medications: precaution is hypertension >180/110 hypotension 90/50

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