A recent paper on EECP and its hemodynamic effects on stroke patients has recently been published in the Biomedical Engineering Journal (Li et al. BioMed Eng OnLine (2019) 18:91 https://doi.org/10.1186/s12938-019-0710-x). The following are comments and information shared by Bill Seychell, Director of Clinical Affairs for Vasomedical Inc.
Please see the attached clinical paper demonstrating the hemodynamic effects of EECP on stroke patients. EECP is NOT FDA Cleared or CMS reimbursed for stroke patients in the United States. Other countries are governed by their own regulating agencies. In the United States EECP is FDA Cleared and CMS reimbursed for “Refractory Angina”.(See attached FDA reclassification).
The two primary points I’d like to draw from the Hemodynamics paper are the importance of pressure and time. For several on this email distribution this is a drastic simplification of the information provided. For the EECP clinician it is basic information which supports principals of treatment provided during clinical training.
MAP Mean Arterial Pressure is average blood pressure. CBP Cerebral Blood Flow is the blood flow through major blood vessels in the brain. WSS Wall Shear Stress is the flow and friction of blood flowing through blood vessels. Cerebral Autoregulation is the brain’s ability to manage and regulate its own blood pressure.
This study demonstrates the importance of treating patients at full standard treatment pressure 260 mmHg for TS 3 & TS 4, 240mmHg for the Lumenair. The reason for lower pressure with the Lumenair is due to direct pressure delivery. Vasomedical EECP systems provide the best pressure delivery of all external counter pulsation systems; with the quickest pressure rise, longest pressure hold and best pressure release. (Table 1 demonstrates pressure delivery for each cuff and pressure and flow of blood in the brain. Pressure slide demonstrates Vasomedical system pressure delivery.) Standard treatment pressures allow for variable delivery pressures (about 200mmHg) lost to hoses and cuff application. This study focuses on brain pressure and flow which is managed by cerebral autoregulation, these measurements may also reflect pressure and flow of blood throughout the body.
Inflation Duration, the length of time cuffs are inflated, is expressed in this paper as pressurization duration. Increasing Inflation duration during the cardiac cycle optimizes blood flow MAP & WSS for better possible patient outcomes. The understanding of inflation and deflation timing based upon the finger plethysmograph provides the therapist with the knowledge to provide optimal EECP therapy.
The EECP therapist understands that electrical systoli seen as the R wave on the ECG always precedes mechanical systoli, heart muscle contraction and pumping of blood, as seen as the a rise in pressure on the finger plethysmograph wave form.
The therapist always draws a line from the R wave of the ECG down through the finger plethysmograph waveform to identify:
S-Systoli, the rise in pressure created by the heart
T- Transition the pressure drop due to closure of the aortic valve
D- Augmented Diastoli, the rise in pressure created with EECP
EDP- End Diastolic Pressure, the drop on pressure caused by cuff deflation
Cuff Inflation is timed to aortic valve closure seen at the transition of the finger pleth. wave.
Cuff Deflation is timed to the EDP End Diastolic Pressure lowering vascular resistance with its effect on reducing Systolic Pressure
The Therapist is the KEY to optimal patient outcomes with EECP.
For your information and consideration.
Keep your SQUEEZE on!
Bill