• Sen Lin, Ming Liu, Bo Wu, Zilong Hao, Jie Yang, and Wendan Tao.
• Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
• Cochrane Db Syst Rev. 2012 Jan 1; 1: CD009264.

BackgroundExternal counterpulsation (ECP) may improve cerebral blood flow, and it has been proposed as a potential therapy for patients with ischaemic stroke.ObjectivesTo assess the efficacy and safety of ECP for acute ischaemic stroke.Search MethodsWe searched the Cochrane Stroke Group Trials Register (June 2011), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2011 Issue 2), MEDLINE (1948 to June 2011), EMBASE (1980 to June 2011), CINAHL (1982 to June 2011), AMED (Allied and Complementary Medicine) (1985 to June 2011), China Biological Medicine Database (CBM) (1978 to June 2011), Chinese National Knowledge Infrastructure (CNKI) (1979 to June 2011), Chinese Science and Technique Journals Database (VIP) (1989 to June 2011) and Wanfang Data (1984 to June 2011). We also searched ongoing trials registers, reference lists and relevant conference proceedings and contacted authors and manufacturers of external counterpulsation devices.Selection CriteriaRandomised controlled trials (RCTs) in which ECP (started within seven days of stroke onset) was compared with sham treatment or no treatment, or ECP plus routine treatment was compared with routine treatment alone, in patients with acute ischaemic stroke.Data Collection And AnalysisTwo review authors independently assessed trial quality and extracted data, checked for adverse events data and contacted trialists for missing information.Main ResultsWe included two trials involving 160 patients. Numbers of death or dependent patients at the end of at least three months follow-up were not reported in either of the included trials. The outcome measure used in the included trials was only the number of participants with improvement of neurological impairment after treatment according to the Modified Edinburgh-Scandinavian Stroke Scale (MESSS) or self-making criteria. ECP was associated with a significant increase in the number of participants whose neurological impairment improved (risk ratio (RR) 1.75, 95% confidence interval (CI) 1.37 to 2.23). Only one trial reported no adverse events.Authors' ConclusionsThe methodological quality of the included studies was poor, and reliable conclusions could not be drawn from the present data. High-quality and large-scale RCTs are needed.

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