Enhanced external counterpulsation improves skin oxygenation and perfusion

Eur J Clin Invest. 2004 Jun;34(6):385-91. doi: 10.1111/j.1365-2362.2004.01352.x.


Background: Enhanced external counterpulsation (EECP) augments diastolic and reduces systolic blood pressures. Enhanced external counterpulsation has been shown to improve blood flow in various organ systems. Beneficial effects on skin perfusion might allow EECP to be used in patients with skin malperfusion problems. This study was performed to assess acute effects of EECP on superficial skin blood flow, transdermal oxygen and carbon dioxide pressures.

Materials and methods: We monitored heart rate, blood pressure, transdermal blood flow as well as oxygen and carbon dioxide pressures in 23 young, healthy persons (28 +/- 4 years) and 15 older patients (64 +/- 7 years) with coronary artery disease before, during and 3 min after 5 min EECP. Friedman test was used to compare the results of 90-s epochs before, during and after EECP. Significance was set at P < 0.05.

Results: Enhanced external counterpulsation increased heart rate and mean blood pressure. During EECP, transdermal oxygen pressure and concentration of moving blood cells increased while transdermal carbon dioxide pressure and velocity of moving blood cells decreased significantly in both groups. After EECP, transdermal carbon dioxide pressure was still reduced while the other parameters returned to baseline values.

Conclusions: Improved skin oxygenation and carbon dioxide clearance during EECP seem to result from the increased concentration and reduced flow velocity, i.e. prolonged contact time, of erythrocytes. The increased concentration of moving blood cells and the decreased velocity of moving blood cells at both tested skin sites indicate peripheral vasodilatation.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Blood Flow Velocity
  • Carbon Dioxide / blood
  • Coronary Disease / blood
  • Coronary Disease / physiopathology
  • Coronary Disease / therapy*
  • Counterpulsation*
  • Humans
  • Male
  • Middle Aged
  • Oxygen / blood*
  • Partial Pressure
  • Regional Blood Flow
  • Skin / blood supply*


  • Carbon Dioxide
  • Oxygen