What are pneumatic compression devices?

What Are Pneumatic Compression Devices

Pneumatic compression devices are medical devices that intermittently apply external pressure to the limbs through inflatable cuffs, designed to enhance blood flow and prevent venous thromboembolism or treat vascular insufficiency conditions.

Device Mechanism and Function

Pneumatic compression devices work through sequential inflation and deflation of pneumatic cuffs placed on the leg, which produces several physiological effects 1:

• Increases arterial blood flow, peak systolic blood flow, and pulse volume through mechanical compression of the vasculature 1, 2
• Enhances venous return by increasing the arteriovenous pressure gradient 1, 2
• Reverses vasomotor paralysis in compromised vascular beds 1, 2
• Stimulates nitric oxide release, promoting vasodilation 1, 2
• Promotes venous emptying by applying external pressure on calf muscles and vasculature 1

Clinical Applications

Deep Vein Thrombosis Prevention

Intermittent pneumatic compression devices reduce DVT risk by approximately 50% compared to no treatment 1. The American College of Chest Physicians recommends these devices for 3:

• Acutely ill hospitalized medical patients at increased risk of thrombosis who are bleeding or at high risk for major bleeding as a substitute for pharmacological thromboprophylaxis 3
• Patients with intracerebral hemorrhage beginning on the day of hospital admission 3
• Critically ill patients who are bleeding or at high bleeding risk until the bleeding risk decreases 3
• Bedridden patients unable to ambulate due to trauma, orthopedic surgery, neurosurgery, or other circumstances 3

In high-risk stroke patients with restricted mobility, this translates to a reduction of 36 symptomatic VTE events per 1,000 patients treated 1.

Chronic Limb-Threatening Ischemia (No-Option CLTI)

For patients with no-option CLTI, intermittent pneumatic compression may provide 1:

• Reduction in ischemic rest pain with demonstrated benefit in multiple studies 1
• Improved wound healing rates of 26% at 1-3 months 1
• Limb salvage rates of 58-83% at 1-3 months and 58-94% at 1.5-3.5 years 1
• Prolonged amputation-free survival though no significant reduction in major amputation rates 1

Lymphedema Management

The American Heart Association recommends that for patients with moderate or severe lymphedema and significant edema, a trial of an intermittent compression device is reasonable 2. Recent evidence shows devices designed to mimic manual lymphatic drainage are more effective than traditional sequential compression in reducing distal leg volume (mean reduction: 230 mL vs. 140 mL, p = 0.01) 4.

Device Types and Technology

Sequential compression devices inflate multiple chambers in a specific sequence from distal to proximal 1, 2. Newer generation devices like the ACTitouch combine sustained compression with intermittent pneumatic compression, providing automatic pressure adjustment every 30 minutes 5.

Contraindications and Safety Considerations

Arterial insufficiency is an absolute contraindication and must be ruled out before recommending compression therapy 2, 3. Additional safety concerns include 6:

• Peroneal neuropathy risk in patients with significant weight loss or cancer-related cachexia 6
• Compartment syndrome risk during prolonged surgery, particularly in lithotomy position 6
• Skin complications though data on this outcome remain limited 1

Practical Implementation Considerations

The American College of Chest Physicians provides specific guidance 3:

• Do not use routinely in low-risk patients as they provide no additional benefit when thrombosis risk is low 3
• Transition to pharmacological prophylaxis when bleeding risk decreases 3
• Not recommended for chronically immobilized persons residing at home or nursing homes 3
• Not recommended for intra-operative use during craniotomy 3

Disadvantages include expense and inconvenience, particularly the need to use the device for several hours each day 2. Patient compliance data shows self-reported usage time overestimates actual use by an average of 2.5 hours, with limits of agreement ranging from -6 to +11 hours 5.