Portable enhanced external counterpulsation for acute coronary syndrome and cardiogenic shock: a pilot study

Abstract

Background: Enhanced external counterpulsation (EECP) currently is used as an outpatient therapy for patients with refractory chronic angina.

Hypothesis: We sought to determine the safety and feasibility of a portable EECP unit to treat patients with acute coronary syndrome and/or cardiogenic shock in the coronary care unit (CCU).

Methods: Ten patients with acute coronary syndrome and/or cardiogenic shock who were not considered candidates for invasive intra-aortic balloon counterpulsation (IABP) by the treating cardiologist were prospectively enrolled in this single-center study. Each patient received 2-4 one-hour EECP treatments performed at the bedside in the CCU. Anticoagulation or recent femoral access was not an exclusion criterion.

Results: The mean age was 58 +/- 19 years (range 28-81), and half were women. Patients had either acute coronary syndrome alone (n = 4), cardiogenic shock alone (n = 3), or both (n = 3). The cardiac indications for study enrollment included: acute inferior wall ST-segment elevation myocardial infarction with cardiogenic shock (n = 2), non-ST-segment elevation myocardial infarction with postinfarction angina (n = 2) or heart failure (n = 1), unstable angina with refractory rest angina (n = 2), cardiogenic shock from ischemic cardiomyopathy with severe mitral regurgitation (n = 1), and cardiogenic shock from nonischemic cardiomyopathy (n = 2). No adverse events were recorded during or as a consequence of EECP therapy, including no bleeding complications, no heart failure exacerbations, and no skin breakdown. The portable EECP unit did not interfere with ongoing critical care nursing.

Conclusions: EECP is safe and feasible for acute bedside therapy of critically ill patients with acute coronary syndrome and/or cardiogenic shock who are not candidates for IABP.