The history of Enhanced External Counterpulsation (EECP) dates back to the 1950s when researchers identified that increasing coronary perfusion could enhance blood flow to ischemic heart tissue. This concept led to the development of the intra-aortic balloon pump (IABP), a significant advancement in treating cardiogenic shock. 

In the 1960s, a team at Harvard University, led by Dr. Birtwell, created a device that applied pressure to the lower extremities to improve cardiac output and perfusion. However, this early system was not widely adopted due to its complexity. 

The technology evolved in 1976 when Zheng and colleagues introduced a more practical design using three compression cuffs, which inflated and deflated in sync with the cardiac cycle. By the 1980s, further enhancements included the incorporation of hip counterpulsation balloons, leading to a new generation of EECP devices recognized by the international medical community. 

EECP gained FDA approval in the United States in 1995 for treating chronic stable angina. It has since been integrated into clinical guidelines from major cardiovascular organizations, including the American Heart Association and the European Society of Cardiology. Today, EECP is widely used as a safe, effective, and non-invasive treatment for coronary artery disease and heart failure, with ongoing research exploring its broader applications in cardiovascular care. 

Before beginning EECP, patients must: 

1. Obtain a physician referral 

2. Schedule pre-treatment appointments

3. Nursing assessment 

4. Stress test 

5. Orientation  

The nursing assessment includes: 

• Review of medical history and contraindications 

• Provision of an angina diary to record chest pain episodes 

• Comprehensive information about EECP treatment 

• Completion of questionnaires to assess chest pain severity 

Patients undergo two stress tests: 

• Pre-treatment: Establishes baseline exercise capacity and chest pain patterns 

• Post-treatment: Conducted after 35 sessions to measure improvements 

These tests evaluate changes in exercise capacity and chest pain frequency, severity, and duration. 

The orientation session includes: 

• Familiarization with the treatment room and equipment 

• Detailed explanation of the EECP process 

• 15-minute trial run on the ECP machine 

• Opportunity to address patient questions 

The first official treatment session begins the following day. 

EECP is primarily for patients with disabling stable angina (Class III or IV Canadian Cardiovascular Society or equivalent) who are not suitable candidates for surgical intervention due to: 

• High risk of operative complications or failure 

• Unsuitable coronary anatomy 

• Excessive risk from co-morbid conditions

EECP is not recommended for patients with: 

• Hypertrophic cardiomyopathy 

• Congenital heart disease 

• Valvular disease 

• Enlarged heart 

• Pacemaker 

• Hemorrhage 

• Atrial fibrillation 

• Pulmonary hypertension 

• Blood clots 

• Peripheral artery disease 

• Severe hypertension 

• Resting heart rate exceeding 120 bpm