EA for SU

…in neurocritical patients.

Inspired by Li et al 2022.[1]

Potential mean saving of £10 000 per patient through use of EA.

EA – electroacupuncture
SU – stress ulceration
GI – gastrointestinal…
VEGF – vascular endothelial growth factor
HSP70 – heat shock protein 70
TFF2 – trefoil factor family 2

key to acronyms

This is quite a novel paper, even by Chinese acupuncture standards. There are a couple of laboratory studies on rodent models of stress ulceration and acupuncture treatment, but they are both in Chinese. This looks to be the first paper in humans in English, so is well worth highlighting here.

The paper is published in Frontiers in Medicine, which has an impact factor of just over 5. It has been around since March 2014, but the Frontiers journals were first launched by a couple of neuroscience researchers from Switzerland as a non-profit enterprise in 2007. One of them, Kamila Markam, spoke about it at TEDx Brussels in 2017.

The trial was based in Shanghai and the population was drawn from patients with intracranial bleeds listed for neurosurgical decompression. Patients were recruited if they had signs of SU prior to surgery, ie signs of upper GI bleeding.

Patients (n=86) were equally allocated to either standard care or the addition of EA treatment. EA was performed prior to surgery and twice a day thereafter for 5 days. EA was applied for 30 minutes at 2/100Hz and 2mA to the points ST36 and ST34.

Outcomes were all objective, and whilst the primary outcome was ‘effective rate’, this was measured through testing gastric fluid for the presence of occult blood. After 3 days, 85% of patients in the EA group had no signs of SU, as opposed to 58% in the control group.

Secondary outcomes included ICU and hospital stays, and both of these were significantly shorter in the EA treated group. The ICU stay was reduced by ~45% (from a mean of 11 to 6 days) and the hospital stay by ~27% (from a mean of ~22 to ~16 days). This would result in a significant cost saving considering that a typical ICU stay costs over £1500 a day (data from the UK in 2016/17).

Other secondary outcomes investigated possible mechanistic factors. Serum levels of VEGF, HSP70 and TFF2 were all significantly higher in the EA group on day 3 and day 5 (on day 1 also for the latter 2 markers). Of the 3 factors, TFF2 appears to be most specific to GI mucosal protection. HSP70 is involved in protein folding and VEGF stimulates new blood vessel formation.

So, here we have another use for EA at ST36, as well as saving you from GI sepsis (as discussed in a previous blog) it can improve recovery from stress ulceration, and potentially save thousands in ICU costs per patient. What are we waiting for… a patent?

Addendum

Whilst recording the blog I calculated the cost saving in the EA group and was astonished to come up with the figure of £400 000 (based on a mean reduction of 6 days in ICU stay, £2000 per day in a UK ICU for a neurocritical patient, and 40 patients in the EA group).

References

1. Li H, Li L-L, Wang J, et al. Effect of electroacupuncture on the repair of stress ulcer injury in neurocritical patients: A randomized clinical trial. Front Med 2022;9:1001584. doi:10.3389/fmed.2022.1001584

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Declaration of interests MC