Evidence map›Paper›PMID 26347398›Full record

Trial reportJournal of stroke and cerebrovascular diseases : the official journal of National Stroke Association2015

Feasibility and Safety of Using External Counterpulsation to Augment Cerebral Blood Flow in Acute Ischemic Stroke-The Counterpulsation to Upgrade Forward Flow in Stroke (CUFFS) Trial.

Kama Z Guluma, David S Liebeskind, Rema Raman, Karen S Rapp, Karin B Ernstrom, Andrei V Alexandrov, Reza B Shahripour, Kristian Barlinn, Sidney Starkman, Ileana D Grunberg and 3 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
0.4field-weighted citation impact, top 33% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it, 16 citations in OpenAlex.

  1. Guideline
  2. Trial
  3. Article
  4. Article
  5. Review
  6. Article
  7. Review
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 5 institutions in 2 countries.

Kama Z GulumaDepartment of Emergency Medicine, University of California, San Diego, California, USA. Electronic address: kguluma@ucsd.edu.
David S LiebeskindUCLA Stroke Center, Department of Neurology, University of California, Los Angeles, California, USA.
Rema RamanFamily Medicine and Public Health and Neurosciences, University of California, San Diego, La Jolla, California, USA.
Karen S RappUCSD Stroke and Coordinating Center, University of California, San Diego, La Jolla, California, USA.
Karin B ErnstromFamily Medicine & Public Health, University of California, San Diego, La Jolla, California, USA.
Andrei V AlexandrovDepartment of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Reza B ShahripourNeurosonology, Comprehensive Stroke Center, University of Alabama, Birmingham, Alabama, USA.
Kristian BarlinnDepartment of Neurology, Dresden University Stroke Center, Carl Gustav Carus University Hospital Dresden, Dresden, Germany.
Sidney StarkmanUCLA Stroke Center and Departments of Emergency Medicine and Neurology, University of California, Los Angeles, California, USA.
Ileana D GrunbergUCLA Stroke Network, University of California, Los Angeles, California, USA.
Thomas M HemmenDepartment of Neurosciences, UCSD Stroke Program, University of California, San Diego, La Jolla, California, USA.
Brett C MeyerDepartment of Neurosciences, UCSD Stroke Program, University of California, San Diego, La Jolla, California, USA.
Anne W AlexandrovCollege of Nursing, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
University of California, San Diego · USUniversity of California, Los Angeles · USUniversity of Tennessee Health Science Center · USUniversity Hospital Carl Gustav Carus · DEUniversity of Alabama at Birmingham · US

Funding

UCLA SPOTRIAS CENTER APPLICATION RENEWAL-PROGRAM PROJECTP50NS044378 · NINDS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI VINTERS, HARRY V. · 2003 to 2012
$17.2M
UltrasoundP50NS044148 · NINDS · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI MEYER, BRETT C · 2003 to 2012
$15.1M
NINDS NIH HHS P50 NS044148NINDS NIH HHS P50NS044148NINDS NIH HHS P50 NS044378NINDS NIH HHS P50NS044378
6 · The paper itself

Abstract

backgroundExternal counterpulsation (ECP) increases perfusion to a variety of organs and may be helpful for acute stroke.

methodsWe conducted a single-blinded, prospective, randomized controlled feasibility and safety trial of ECP for acute middle cerebral artery (MCA) ischemic stroke. Twenty-three patients presenting within 48 hours of symptom onset were randomized into one of two groups. One group was treated with ECP for 1 hour at a pressure of up to 300 mmHg ("full pressure"). During the procedure, we also determined the highest possible pressure that would augment MCA mean flow velocity (MFV) by 15%. The other group was treated with ECP at 75 mmHg ("sham pressure"). Transcranial Doppler MCA flow velocities and National Institutes of Health Stroke Scale (NIHSS) scores of both groups were checked before, during, and after ECP. Outcomes were assessed at 30 days after randomization.

resultsAlthough the procedures were feasible to implement, there was a frequent inability to augment MFV by 15% despite maximal pressures in full-pressure patients. In sham-pressure patients, however, MFV frequently increased as shown by increases in peak systolic velocity and end diastolic velocity. In both groups, starting ECP was often associated with contemporaneous improvements in NIHSS stroke scores. There were no between-group differences in NIHSS, modified Rankin Scale Scores, and Barthel Indices, and no device or treatment-related serious adverse events, deaths, intracerebral hemorrhages, or episodes of acute neuro-worsening.

conclusionsECP was safe and feasible to use in patients with acute ischemic stroke. It was associated with unexpected effects on flow velocity, and contemporaneous improvements in NIHSS score regardless of pressure used, with a possibility that even very low ECP pressures had an effect. Further study is warranted.

Indexed as

Treatment OutcomeAgedBrain IschemiaCerebrovascular CirculationCounterpulsationFeasibility StudiesFemaleHumansMaleMiddle AgedNeurologic ExaminationProspective StudiesSeverity of Illness IndexSingle-Blind MethodStrokeTime FactorsCerebral blood flow velocityExternal counterpulsationIschemic strokeTranscranial Doppler

Identifiers

PMID26347398
PMCPMC4630102
OpenAlexW1919043697

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.