Muscular counterpulsation: preliminary results of a non-invasive alternative to intra-aortic balloon pump

OBJECTIVES: IABP is the most widely used form of temporary cardiac assist and its benefits are well established. We designed an animal study to evaluate a device based on muscular counterpulsation (MCP) that should reproduce the same hemodynamic effects as IABP in a completely non-invasive way. METHODS: Six calves, 60+/-4 kg, divided into 2 groups, in general anaesthesia, equipped with EKG, Swan-Ganz, pressure probe in the femoral artery and flow probe in the left carotid artery, received either IABP through right femoral artery, or muscle counterpulsation (MCP). MCP consists of electrically induced skeletal muscle contraction during early diastole, triggered by EKG and microprocessor controlled by a portable device. For each animal the following parameters were also considered: mean aortic pressure (mAoP), CO, CI, left ventricular stroke work index (LVSWI), systemic vascular resistance (SVR) and mean femoral artery flow (Faf). We did 3 sets of measurements: baseline (BL), after 20 (M20) and 40 (M40) min of cardiac assistance. These measurements have been repeated after 40 min of rest for 3 times. Results are expressed as mean+/-SD. RESULTS: Baseline values: mAoP, 76.51+/-12 mmHg; mCVP, 11.5+/-3 mmHg; CO, 5+/-1 l/min per m(2); LVSWI, 0.77+/-0.2 KJ/m(2); SVR, 1040+/-15 dyns/cm(-5); Faf, 75.5+/-10 ml/min. IABP group: mAoP, 81.1+/-6 mmHg; mCVP, 1+/-0.1 mmHg; CO, 4.5+/-0.7 l/min per m(2); LVSWI, 0.69+/-0.2 KJ/m(2); SVR, 1424+/-8 dyns/cm(-5); Faf, 64.3+/-3 ml/min. MCP group: mAoP, 60.1+/-7 mmHg; mCVP, 23.6+/-2 mmHg; CO, 4.8+/-0.4 l/min per m(2); LVSWI, 0.69+/-0.2 KJ/m(2); SVR, 608+/-25 dyns/cm(-5); Faf, 92.3+/-12 ml/min. CONCLUSIONS: MCP and IABP had the same effects on CO and LVSWI. Moreover, MCP reduced SVR and increased the peripheral circulation without requiring any vascular access nor anticoagulation therapy

ECG-triggered muscular counterpulsation for treatment of low cardiac output

Skeletal muscular counterpulsation (MCP) has been used as a new noninvasive technique for treatment of low cardiac output. The MCP method is based on ECG-triggered skeletal muscle stimulation. The purpose of the present study was to evaluate acute hemodynamic changes induced by MCP in the experimental animal

ECG-triggered skeletal muscle stimulation improves hemodynamics and physical performance of heart failure patients

BACKGROUND: Muscular counterpulsation (MCP) was developed for circulatory assistance by stimulation of peripheral skeletal muscles. We report on a clinical MCP study in patients with and without chronic heart failure (CHF). METHODS AND RESULTS: MCP treatment was applied (30 patients treated, 25 controls, all under optimal therapy) for 30 minutes during eight days by an ECG-triggered, battery-powered, portable pulse generator with skin electrodes inducing light contractions of calf and thigh muscles, sequentially stimulated at early diastole. Hemodynamic parameters (ECG, blood pressure and echocardiography) were measured one day before and one day after the treatment period in two groups: Group 1 (9 MCP, 11 no MCP) with ejection fraction (EF) above 40% and Group 2 (21 MCP, 14 no MCP) below 40%. In Group 2 (all patients suffering from CHF) mean EF increased by 21% (p<0.001) and stroke volume by 13% (p<0.001), while end systolic volume decreased by 23% (p<0.001). In Group 1, the increase in EF (6%) and stroke volume (8%) was also significant (p<0.05) but less pronounced than in Group 2. Physical exercise duration and walking distance increased in Group 2 by 56% and 72%, respectively. CONCLUSIONS: Noninvasive MCP treatment for eight days substantially improves cardiac function and physical performance in patients with CHF

Original method of external muscular counter-pulsation in coronary heart disease patients at cardiosurgery clinic

Aim. To assess the effects of external muscular counter-pulsation (MCP) in early post-operation period among coronary heart disease (CHD) patients, who underwent coronary aortic bypass graft (CABG) surgery. Мaterial and methods. 47 CHD patients (all males, functional class of angina 3.4±0.08), after on-pump CABG, were divided into two groups. In the main group (n=29), starting at Day 1-2 after CABG, standard therapy was combined with MCP course (CardioLa device, Switzerland). Control group (n=18) was observed according to standard protocol. The methods used included echocardiography (EchoCG) and tetrapolar thoracic impedancometry at rest. Results. MCP facilitated normalization of central and peripheral hemodynamics, disturbed due to on-pump intervention. In main group, stroke volume (р&lt;0.002), stroke index (р&lt;0.003), minute volume (р&lt;0.0001), cardiac index (р&lt;0.0001) and total ejection fraction (р&lt;0.0001) increased, according to EchoCG at rest, and total peripheral resistance decreased, according to tetrapolar thoracic impedancometry results, comparing to control group. The number of post-operation days at the hospital was significantly lower in main group, comparing with controls (р&lt;0.0001). Conclusion. MCP is highly effective for stabilization and improvement of central and peripheral hemodynamics in early post-CABG period