Frequently Asked Questions – Patients

Renew™ ECP Therapy is a non-invasive and non-surgical therapy process that uses a medical device to deliver External Counterpulsation (ECP). ECP enhances blood flow through timed inflation of pressure cuffs wrapped around the calves, thighs and hips. The inflation of pressure cuffs occurs in between each heartbeat, compressing the blood vessels and pumping blood back to the heart and throughout the body.

This enhanced blood flow brings about a multitude of health benefits.

Three sets of inflatable pressure cuffs, much like ordinary blood pressure cuffs, are wrapped around the calves, thighs and hips. ECG electrodes applied to the chest enable the Renew™ NCP-5 system to time cuffs inflation precisely to the rhythm of your heartbeat. When the heart is at rest, the cuffs are inflated sequentially from the calves to the hips. This compresses the blood vessels, thus enhancing circulation of blood flow back to the heart. Prior to the next heartbeat, all three cuffs deflate simultaneously. The rapid deflation of the cuffs significantly reduces the amount of work required of the heart to pump oxygenated blood to the rest of the body.

The earliest ECP devices inflated all the cuffs simultaneously. To better "milk" blood from the legs, more recent devices inflate the cuffs in a sequential manner: first the calves, then the thighs, then the hips. This improved version of ECP is often called "enhanced ECP". Since all modern ECP machines use some variant of the "enhanced" method, the terms ECP and enhanced ECP are sometimes used interchangeably. Renew™ NCP-5 uses the enhanced ECP technology.

Renew™ ECP Therapy enhances blood flow to all parts of the body, including organs such as the brain, heart, kidneys, liver and skin. With improved blood circulation, this increases delivery of oxygen and nutrients and removal of carbon dioxide and waste products. Clinical evidences also indicate that ECP promotes vascular health (fitness of the arteries) and reduces inflammation1, hence reducing the risk of cardiovascular diseases.

Renew™ NCP-5 ECP device is cleared by the U.S. FDA for the treatment of chronic stable angina (chest pain due to poor blood supply to the heart). Many clinical studies have shown ECP therapy to be effective in reducing angina symptoms and improving exercise capacity in patients with angina pectoris2.

As with most medical-related procedures, results may vary from patient to patient.

Renew™ NCP-5 ECP device is U.S. FDA-cleared for the treatment of chronic stable angina. However, many clinical studies have also shown ECP to have beneficial effects for symptoms associated with poor blood flow, such as:

  • Fatigue and weakness
  • Shortness of breath
  • Dizziness
  • Numbness
  • Swelling

If you have any conditions listed on the Contraindications, you should not undergo Renew™ ECP Therapy.

Speak to your doctor to find out if Renew™ ECP Therapy is suitable for you.

It feels like a firm massage with pressure applied to the hips and legs at regular intervals. The intensity of the pressure is adjustable to ensure a comfortable and effective treatment.

If the cuffs are not adjusted properly or the pressure is set too high for you, tenderness or bruising may occur. Extra padding can be arranged and the pressure setting can be adjusted to your comfort.

Individuals with blood clots or past history of blood clots should not undergo Renew™ ECP Therapy.

If you have any conditions listed under the Contraindications, you should not undergo Renew™ ECP Therapy.

Individuals often feel invigorated after a treatment session. The increase in blood circulation may cause you to feel flushed or warm; your face and hands may appear mildly flushed for an hour or two after a treatment. You may have an appearance similar to what you would have after a round of active exercise. Occasionally, a person may feel slightly light-headed or have a mild headache due to the increase in blood circulation or lack of hydration. However, this usually passes in a few moments.

Renew™ ECP Therapy is an external procedure that is non-surgical and virtually risk-free. It does not require hospitalisation or the use of drugs. Clinical studies have shown that results for ECP therapy are comparable to that of traditional treatment methods such as angioplasty and bypass surgery. Its impact has been significant in many patients, with long-lasting effects of up to 5 years.16

Many studies have shown that ECP can be of substantial benefit for some patients with CHF.3,4 You should check with your healthcare provider to see if ECP would be appropriate and beneficial for you.

You are encouraged to consult your doctor or your healthcare provider before undergoing Renew™ ECP Therapy if you have just undergone any of the treatments stated above. Generally, you should only begin ECP therapy at least 6 weeks after surgical intervention and if your wounds have completely healed.

If your blood pressure is now under control, you can have ECP therapy. If your blood pressure is elevated, you should first consult your healthcare provider. Once your blood pressure has been controlled, ECP therapy should be fine.

Renew™ ECP Therapy promotes blood circulation in the whole body, including the limbs. However, if you have severe obstruction of blood flow to your legs, you may not be suited for Renew™ ECP Therapy. If your toes are blue or black or you have no sensation in your feet, you are advised to check with your healthcare provider first.

Some pacemakers may make it difficult for the ECP machine to synchronise with their heartbeats. However, “single-chamber” type pacemakers are generally accepted.

Certainly. If your doctor has cleared you to undergo exercise and physical activity, you may exercise before or after you receive Renew™ ECP Therapy.

Clinical studies have shown ECP to be effective with improving exercise capacity in patients with angina pectoris2. Many people find Renew™ ECP Therapy to be beneficial after a vigorous workout. As ECP therapy improves blood flow to peripheral arteries17 and organs18, this can promote the removal of metabolites, such as lactic acid, thus helping in recovery from sports and exercise.

For treatment of chronic stable angina, the established treatment time is 60 minutes per session. For other individuals, treatment duration may be advised by a healthcare professional.

For treatment of chronic stable angina, the established duration is 35 treatment sessions over 7 to 8 weeks (approximately 4 to 5 treatment sessions per week). For other individuals, treatment duration may be advised by a healthcare professional.

Yes. You may tell the operator that you wish to stop treatment at any time during the session. There is also an emergency stop button which you may use should you feel an urgent need to stop the treatment. You are encouraged to use the toilet before each session starts in order to minimize disruptions.

Missing a session will not harm you. You may just continue with your next scheduled treatment. However, regular sessions are recommended for maximum benefits.

Results may vary between individuals. While most individuals feel some effect after the first session, all will feel greater improvements as the course of treatment progresses.

Clinical studies have shown that effects persist in some patients for up to 5 years.16

Yes. Many individuals choose to continue treatment sessions on a regular basis after their full course of treatment has been completed for health maintenance.

There are no age restrictions. However, minors require the consent of their parent or guardian prior to receiving Renew™ ECP Therapy.


References

  1. Yang, D.Y. and G.F. Wu, Vasculoprotective properties of enhanced external counterpulsation for coronary artery disease: beyond the hemodynamics. Int J Cardiol, 2013. 166(1): p. 38-43.
  2. Loh, P.H., et al., Enhanced external counterpulsation in the treatment of chronic refractory angina: a long-term follow-up outcome from the International Enhanced External Counterpulsation Patient Registry. Clin Cardiol, 2008. 31(4): p. 159-64.
  3. Feldman, A.M., et al., Enhanced external counterpulsation improves exercise tolerance in patients with chronic heart failure. J Am Coll Cardiol, 2006. 48(6): p. 1198-205.
  4. Abbottsmith, C. W., et al., Enhanced external counterpulsation improves exercise duration and peak oxygen consumption in older patients with heart failure: a subgroup analysis of the PEECH trial. Congest Heart Fail, 2006. 12(6), p. 307-311.
  5. Martin, J.S., et al., Enhanced external counterpulsation improves peripheral artery function and glucose tolerance in subjects with abnormal glucose tolerance. J Appl Physiol (1985), 2012. 112(5): p. 868-76.
  6. Martin, J.S. and R.W. Braith, Anti-inflammatory effects of enhanced external counterpulsation in subjects with abnormal glucose tolerance. Appl Physiol Nutr Metab, 2012. 37(6): p. 1251-5.
  7. Campbell, A.R., et al., Enhanced external counterpulsation improves systolic blood pressure in patients with refractory angina. Am Heart J, 2008. 156(6): p. 1217-22.
  8. Casey, D.P., et al., Effects of enhanced external counterpulsation on arterial stiffness and myocardial oxygen demand in patients with chronic angina pectoris. Am J Cardiol, 2011. 107(10): p. 1466-72.
  9. Braverman, D.L., et al., The safety and efficacy of enhanced external counterpulsation as a treatment for angina in patients with aortic stenosis. Clin Cardiol, 2013. 36(2): p. 82-7.
  10. Lin, W., et al., Predictors of good functional outcome in counterpulsation-treated recent ischaemic stroke patients. BMJ Open, 2013. 3(6).
  11. Han, J.H., et al., Preliminary findings of external counterpulsation for ischemic stroke patient with large artery occlusive disease. Stroke, 2008. 39(4): p. 1340-3
  12. Applebaum, R.M., et al., Sequential external counterpulsation increases cerebral and renal blood flow. Am Heart J, 1997. 133(6): p. 611-5.
  13. Werner, D., et al., Enhanced external counterpulsation: a new technique to augment renal function in liver cirrhosis. Nephrol Dial Transplant, 2005. 20(5): p. 920-6.
  14. Froschermaier, S.E., et al., Enhanced external counterpulsation as a new treatment modality for patients with erectile dysfunction. Urol Int, 1998. 61(3): p. 168-71.
  15. Lawson, W.E., et al., Effect of enhanced external counterpulsation on medically refractory angina patients with erectile dysfunction. Int J Clin Pract, 2007. 61(5): p. 757-62.
  16. Lawson, W.E., J.C. Hui, and P.F. Cohn, Long-term prognosis of patients with angina treated with enhanced external counterpulsation: five-year follow-up study. Clin Cardiol, 2000. 23(4): p. 254-8.
  17. Braith, R.W., et al., Enhanced external counterpulsation improves peripheral artery flow-mediated dilation in patients with chronic angina: a randomized sham-controlled study. Circulation, 2010. 122(16): p. 1612-20.
  18. Werner, D., et al., Pneumatic external counterpulsation: a new noninvasive method to improve organ perfusion. Am J Cardiol, 1999. 84(8): p. 950-2, A7-8..