IECP devicesBy TMC Europa Ltd.

Increased External Counterpulsation (IECP) is a non-invasive circulatory assist therapy somewhat similar to Intra Aortic Balloon Pump (IABP) and is administered on an outpatient basis. However in IECP a substantially large volume of blood is returned to the heart as compared to IABP and has to be used in chronic phase.

Increased External Counterpulsation (IECP) decreases cardiac workload while increasing myocardial perfusion pressure and cardiac output. The use of Increased External Counterpulsation (IECP) for the outpatient treatment of Coronary Artery Diseases(CAD) and Congestive Heart Failure (CHF) reduces the frequency of Angina (chest pain episodes), increase exercise tolerance, reduce the intake of medications

  • Results of clinical trials show that IECP is a safe and effective choice for people who are considered at high risk for bypass surgery and angioplasty.
  • The procedure is administered in an outpatient setting, does not require any surgery or anaesthetic, and is relatively comfortable both physically and economically for patients

ECP device

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External CounterPulsation (ECP) sequentially compresses the legs from the calves, thighs, buttocks and upper arms, by inflating four sets of foam padded fabric cuffs during diastole


Resulting in...

This results in the movement of blood from the legs to the heart and entire upper body.Pressure, up to the range of 300 mmHg, is applied with the timing and duration of each pulse synchronized with the patient's ECG. When triggered, the pressure pulses applied to the legs and buttocks transmit retrograde pressure through the entire vascular system, raising diastolic aortic pressure and increasing coronary perfusion pressure. The compression of the vascular beds in the legs, buttocks and arms also increases venous return increasing cardiac output.

ECP cuffs rythem


35 sessions

This procedure is carried out in 35 sessions of 1 hour each at a frequency of six days a week, and usually takes 40 days to complete. This is the minimum time protocol to be observed by the External CounterPulsation (ECP) therapist, some patients may require more sittings to maximise their benefits from External CounterPulsation (ECP). The extra numbers of sittings required are decided by the physician depending on the patient's state.



The Benefits

After five years, 64 percent did not need bypass surgery or balloon angioplasty and did not have a major adverse cardiovascular event. This rate is similar to that found in many people who are treated with bypass surgery or angioplasty. A more recent study showed that External CounterPulsation (ECP) procedure relieves angina and improves perfusion (blood flow to the heart) during stress in patients with coronary artery disease. The research was published in the April 1, 2002 issue of the American Journal of Cardiology. Doctors are uncertain exactly how External CounterPulsation (ECP) helps ease angina. The procedure may stimulate the growth of tiny blood vessels in the heart and help bypass blocked blood vessels. This would increase blood flow and oxygen to deprived areas of the heart. External CounterPulsation (ECP) may also improve the function of existing blood vessels..



The Technology

Increased External CounterPulsation (IECP) unequivocally and significantly increases diastolic and mean pressures and reduces systolic pressure in the central aorta and coronary artery. Coronary artery flow, determined by both Doppler and angiographic techniques, is increased during Increased External CounterPulsation (IECP). The combined effects of systolic unloading and increased coronary perfusion pressure provide evidence that Increased External CounterPulsation (IECP) may serve as a potential mechanical assist device.


Summary of Effects of External CounterPulsation

  • Biochemical Markers
  • Increase in Nitric Oxide Levels
  • Decrease in Endothelin Levels
  • Decrease in BNP Levels
  • Increase in VEGF Levels

Functional Measures

  • Increase in Time to ST Depression
  • Increase in Exercise Tolerance
  • Improvement in Peak Oxygen Consumption
  • Increase in Cardiac Contractility
  • Reduction in Systemic Vascular Resistance
  • Decrease in Peak Systolic Pressure


  • Decrease in Peak Systolic Pressure
  • Increase in Ejection Fraction
  • Increase in Cardiac Output
  • Increase in Intra coronary Pressure and Blood Flow Velocity
Clinical Outcomes
  • Decrease in Endothelin Levels
  • Decrease in BNP Levels
  • Increase in VEGF Levels

Buy it from TMC

External Counterpulsation (ECP) an effective form of treatment for angina is still finding itself on a back stage and this effective procedure is still to fall into the mainstream of cardiology practice.

For long interventional cardiologists have been avoiding this safe, non-invasive treatment like a plague, but changes in approach to this procedure are lately being noticed.

For more than a decade since ECP was taken up as a treatment method for life threatening disabilities due to CAD, CHF, and stable angina the world over, its effectiveness in treating these cardio-diseases is beyond doubt a success and is well documented in the text book of cardiology and various cardiology journals.

Years ago a randomised trial with ECP, published in the Journal of the American College of Cardiology (1999), showed that ECP significantly improved both the symptoms of angina and exercise tolerance in patients with coronary artery disease. ECP also significantly improved "quality of life" measures, as compared to placebo therapy.

In one of the issue of Cardiology, investigators report that ECP works even better in patients who have not yet had invasive treatment for angina. Among patients participating in the International ECP Patient Registry who received ECP as first-line therapy (instead of receiving it only after other treatments failed,) 89% experienced an immediate improvement in angina, and 84% reported that the improvement persisted at 6 months.

This compares to a 79% improvement rate with ECP among patients who had already received invasive treatments.

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