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

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

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).

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.

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.

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.