EECP: Safety, Licensing, and Usage for Stroke Recovery

The application and safety issues of EECP (Enhanced External Counterpulsation)?

Recently, there is a grandfather over 65 years old who has a history of stroke.
He has been taking health supplements for six years and has shown improvement in his condition.
Recently, he came across new information about Enhanced External Counterpulsation (EECP) therapy, which is said to facilitate blood circulation.
However, shortly after starting the treatment, he suddenly fainted, and doctors discovered three blocked arteries, necessitating immediate stent placement.
The person who introduced EECP claimed it could help prevent thrombosis during stroke rehabilitation, so there is some confusion about EECP.
I would like to ask the doctor: 1.
Is a license required for EECP in Taiwan? 2.
Can households independently purchase and use EECP? 3.
What symptoms indicate that EECP should or should not be used? Thank you, doctor, for your assistance.

Mr. Chen, 20~29 year old female. Ask Date: 2021/05/11

Dr. Huang Yinghe reply Cardiology

EECP stands for Enhanced External Counterpulsation, a treatment that utilizes synchronized pressure applied to the legs in accordance with the heartbeat to improve blood circulation.
Currently, the medical consensus primarily supports its application for alleviating symptoms of angina, particularly in patients who are unable to undergo catheter-based interventions or coronary artery bypass surgery, or in those who have undergone surgical treatment yet still experience symptoms.
Other applications, such as symptom relief for heart failure, rehabilitation after stroke, and even improvement of male erectile function, are not considered standard treatments but may be considered as options when conventional therapies are unsatisfactory.
Contraindications for EECP include uncontrolled hypertension, moderate to severe valvular heart disease, thrombotic or hemorrhagic conditions, and lower limb infections.
In Taiwan, EECP machines are classified as Class III medical devices and require a physician's prescription and operation; they cannot be purchased or used by the general public independently.

Reply Date: 2021/05/11

More Info

Enhanced External Counterpulsation (EECP) is a non-invasive treatment primarily used for patients with angina or heart failure, particularly those who are not candidates for traditional interventions like angioplasty or bypass surgery. It works by applying pressure to the lower limbs in sync with the heartbeat, which helps to improve blood flow to the heart and potentially other areas of the body, including the brain. However, the safety and appropriateness of EECP for individuals, especially those with a history of stroke or other cardiovascular issues, must be carefully considered.

1. Licensing and Regulation in Taiwan: In Taiwan, EECP devices are classified as Class III medical devices, which means they require a physician's prescription and must be operated by trained medical personnel. This regulation ensures that the treatment is administered safely and effectively, minimizing the risk of complications. Therefore, it is not permissible for individuals or families to purchase and use EECP devices independently without medical oversight.

2. Home Use of EECP: Given the regulatory framework, families cannot autonomously purchase EECP machines for home use. The treatment should be conducted in a clinical setting where medical professionals can monitor the patient's condition and respond to any adverse effects. This is particularly important for elderly patients or those with complex medical histories, such as your grandfather, who has a history of stroke and recent cardiovascular complications.

3. Indications and Contraindications for EECP: While EECP can be beneficial for certain patients, there are specific indications and contraindications that must be taken into account. It is generally indicated for patients with chronic stable angina, heart failure, and those who have not responded to other treatments. However, it is contraindicated in patients with uncontrolled hypertension, significant valvular heart disease, active bleeding disorders, or infections in the lower extremities. Given your grandfather's recent diagnosis of arterial blockage and the need for stenting, it raises concerns about the appropriateness of EECP in his case. The sudden fainting episode he experienced could be indicative of underlying cardiovascular issues that may have been exacerbated by the treatment.

In summary, while EECP may offer potential benefits for certain cardiovascular conditions, its application must be approached with caution, particularly in patients with a history of stroke or significant vascular disease. It is crucial to consult with a healthcare provider who can evaluate the individual risks and benefits based on the patient's overall health status and medical history. The treatment should only be administered in a controlled medical environment, ensuring that any complications can be promptly addressed. If your grandfather is considering EECP as part of his recovery process, it is essential to have a thorough discussion with his healthcare team to determine the best course of action tailored to his specific needs.

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