Management of Long-COVID Postural Orthostatic Tachycardia Syndrome With Enhanced External Counterpulsation, 2021, Varanasi

[ola_cohn]

Abstract

A growing number of patients diagnosed with COVID-19 disease have been reported to have postural orthostatic tachycardia syndrome (POTS) after the acute phase.

A 57-year-old female was diagnosed with COVID-19 in December 2020. As a result of her acute illness, she was hospitalized for COVID pneumonia and respiratory failure, followed by stays at an acute care facility and home rehabilitation center.

After the acute phase, the patient was diagnosed with long-COVID-19-associated POTS with symptoms such as fatigue, “brain fog,” and dyspnea. The patient was referred to an enhanced external counterpulsation (EECP) treatment center and underwent 15, one-hour sessions over three weeks.

Upon completion of therapy, the patient reported improvements with “brain fog” and the ability to perform activities of daily living. Her Patient-Reported Outcome Measurement Information System (PROMIS) Fatigue score was reduced by three points, six-minute walk distance increased by 85 feet, and Duke Activity Status Index (DASI) improved by over 15 points. EECP therapy was chosen due to the overlap in underlying pathology driving POTS and the mechanisms of action of EECP.

This report is the first case of using EECP for the successful management of COVID-19-associated POTS and warrants further trials.

Full text, open access: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8555928/

 

[Hutan]

EECP:

This therapy involves 35 one-hour sessions over the course of seven weeks. Patients lie on a treatment bed with blood pressure-like cuffs that inflate and deflate in accordance with the cardiac cycle. Typically, candidates for EECP include those with chronic stable angina (Canadian Cardiovascular Society (CCS) angina class III or IV) and heart failure with ischemic etiology. Due to the unique mechanism of action of EECP, benefits have been seen in other conditions such as diabetes, hypertension, and erectile dysfunction.

A case study of 1, a potentially profitable treatment with multiple sessions required, the treatment is supposed to help with a whole lot of illnesses.

She indicated that although she continued to experience symptoms, they were less frequent and less severe and occur for a shorter duration.

She had had a pretty bad Covid-19 infection, having been hospitalised for a long time. So she may well have still been recovering.
It's all consistent with a placebo effect.

Enhanced circulation and prevention of fluid build-up would probably help with POTS in the short term, but it's hard to see how the treatment could have a lasting effect.

So, I'm not rushing out for EECP just yet.

 

[Milo]

A case study of 1, a potentially profitable treatment with multiple sessions required, the treatment is supposed to help with a whole lot of illnesses

Nailed it.

Doctors with the dollar sign in mind will be more than happy to provide this treatment to whoever is desperate enough to believe that this study provides objective evidence that it works.

85m more on a 6 minutes walking test? Wowwwwie! I reminds me of our beloved friend with his GET videos, @Graham (RIP)

Edit to add:

Swathi Varanasi declare(s) employment from Flow Therapy. Sachin Shah declare(s) personal fees from Flow Therapy

 

[5vforest]

Not 85 meters, 85 feet. "910 ft at baseline to 995 ft post-EECP". Are you serious?

Also, 3 points on the PROMIS score... is this the scale that goes from 0-40?

I don't even know why I am commenting...

 

[Trish]

Looks like advertising masquerading as science. I wonder whether it's a real journal.

 

[rvallee]

N=1 with a highly fluctuating illness makes this uninterpretable, adding to that the high % of natural recoveries making any attribution basically reaching.

If the "placebo" effect were anything but errors of measurement (or more commonly the error of not being able to measure accurately but pretending that it's OK), this would do nicely:

• The EECP treatment gently but firmly compresses the blood vessels in the lower limbs to increase blood flow to your heart. Each wave of pressure is electronically timed to the heartbeat, so that the increased blood flow is delivered to your heart at the precise moment it is relaxing. When the heart pumps again, pressure is released instantaneously. This lowers resistance in the blood vessels in the legs so that blood may be pumped more easily from your heart.
• EECP may encourage blood vessels to open small channels that become extra branches. These channels or collaterals may eventually become "natural bypass" vessels to provide blood flow to heart muscle. This contributes to the relief of angina symptoms.

So basically a dynamic compression garment, commonly used with POTS. But unlikely to add anything to it.