Lecture Notes: Boston Scientific's ECOS Device

Introduction to ECOS

• Speaker: Dave from Boston Scientific
• Context: Use of ECOS device at Mercy Hospital for over 10 years
• Purpose: Treat patients with thrombus issues

Applications of ECOS

• Types of Thrombus Issues:
  • Arterial leg arteries (SFA)
  • Deep vein thrombosis (DVT) or IVC inclusions
  • Pulmonary embolisms (PE)
• Access Points:
  • Arterial thrombus: opposite groin of treated leg
  • DVT: popliteal vein or brachial vein
  • PE: usually involves both pulmonary arteries, accessed via two sheaths in the same femoral vein

ECOS Device and Procedure

• Catheter Positioning:
  • Inserted directly into the clot
  • Catheter sizes: 12 to 50 cm
• Medication Delivery:
  • TPA (tissue plasminogen activator) infused through catheter
  • Ultrasound transducers inside catheter enhance TPA effectiveness

Mechanism of Action

• Ultrasound Benefits:
  • Low power ultrasound separates fibrin strands in clot
  • Increases clot porosity, enhancing TPA action
• Safety:
  • Reduced TPA dosage decreases bleeding risks
  • Comparable safety to heparin alone
  • Study: 489 patients, zero ICHs

Device Components

• Ports:
  • Drug port for TPA
  • Coolant port for normal saline (cools transducers)
• Heparin:
  • Administered through sheath side port
  • Prevents clotting at access site

Operating the ECOS Machine

• Setup:
  • Two wires (grey and black) connect to corresponding ports
  • Yellow flashing light indicates operation
• Machine Types:
  • Older: one catheter
  • Newer: supports two catheters with separate control channels

Troubleshooting

• Error Codes: Call support with error codes for assistance
• Battery:
  • Lasts approximately 30 minutes to 1 hour
  • Can be bypassed by plugging directly into wall outlet

Post-Treatment

• Catheter Removal:
  • Conducted by ICU nurses
  • Typically follows a venogram or angiogram
• Duration:
  • PE treatments: ~6 hours
  • Leg treatments: ~24 hours

Questions and Responses

• Battery Life: Safe for 30 minutes, potentially up to an hour
• Infusion Pumps: Independent of US machine power
• ICU Protocol: ICU handles catheter removal for PE cases

Conclusion

• Next Steps: Recheck after treatment duration based on type
• Further Questions: No additional questions raised during session