Thrombectomy in rural areas the „flying interventionist“ project
États généraux de l‘AVC 2017 – Lyon Gordian Hubert
Klinikum rechts der Isar www.tempis.de Abteilung für Neuroradiologie 13. 1 November 2017
Foundation of the telestroke network TEMPiS 13. 2 November 2017
Telemedicine in TEMPiS 13. 3 November 2017
Stroke patients in the network
11 000 10 039 10 000 9 411 9 000 8 618 8 000 7 616 7 207 7 000 6 374 5 832 5 987 6 000 5 750 5 216 4 894 5 000 4 649 4 786 4 109 4 000 3 000 2 000 1 000 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 13. 4 November 2017
Number of teleconsultations
7 000 6 356
6 000 5 689 5 448 5 541
5 000 4 513 4 035 4 000 3 560 3 216 3 062 3 187 2 844 2 837 3 000 2 682
1 928 2 000
1 000
0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 13. 5 November 2017
Helsinki and Uusimaa TEMPiS network 1.56 mio (inhabitants) 1.94 million (inhabitants) 9096km² (area) 14992km² (area) 172/km² (population density) 129/km² (population density)
GJ Hubert, et al Stroke 2016 13. 6 November 2017 13. 7 November 2017 13. 8 November 2017 How to implement mechanical thrombectomy in rural areas? 13. 9 November 2017
Problematic Triad
High expertise
Time critical hands on 13. 10 November 2017
Improvement of outcome dependend on time to reperfusion 13. 11 November 2017
TEMPiS Data
Onset IVT - transport Door to Groin to total - IVT transport groin recanalisation
Delays 107 170 45 322min (min) (5:22h) 13. 12 November 2017
Suspected stroke patients: Options for prehospital decision-making
Mothership Drip & model Ship model 13. 13 November 2017
Prehospital decision-making
Is there a third option?
?
Mothership Drip & model Ship model 13. 14 November 2017
Drip and Ship Model
Primary Stroke Center
Comprehensive Stroke Center
Primary Stroke Center
Primary Stroke Center
Patient 13. 15 November 2017
Mothership Model
Primary Stroke Center
Comprehensive Stroke Center
Primary Stroke Center
Primary Stroke Center
Patient 13. 16 November 2017
Endovascular Treatment on Demand
In the TEMPiS model, the mothership becomes a carrier for flying interventionalists 13. 17 November 2017
Drip and Demand Comprehensive Stroke Center (Carrier Model)
Primary Stroke Center
Flying Interventionalist
Primary Stroke Center
Primary Stroke Center
Patient 13. 18 November 2017
Drip and Demand (Carrier Model)
A new option for prehospital triage
Carrier model
Mothership Drip & model Ship model 13. 19 November 2017 13. 20 November 2017
Helicopter Neurointerventionalists Spoke hospital •Close to hospital • Experienced Interventionists •Helicopter airport •Ready at all times • 24/7 •Angiography suite or cardiac angio • Trained to work at all •24/7-Anesthesie angiography suites •(Tele-)Stroke Unit Schwandorf 13. 21 November 2017 Burglengenfeld Cham
Cham Participating hopsitals Regensburg Regen Klinik der Universität Straubing- 4 Regensburg Bogen am Bezirksklinikum Zwiesel Straubing
Freyung-Grafenau Kelheim c Deggendorf Kelheim
Dingolfing- Passau Passau Landshut Landau c Rotthal- Freising Eggenfelden Vilsbiburg münster Freising
Erding Rottal-Inn Dachau Dachau Mühldorf
Pasing Erding 2 Mühldorf a. Inn Altötting Ebersberg Klinikum 8 Harlaching Traunstein Ebersberg München Traunstein Rosenheim Bad Tölz Miesbach
Rosenheim Agatharied Bad Reichenhall Bad Tölz - Wolfratshausen Berchtes- gadener Land 13. 22 November 2017
Time delays
Onset - IVT - transport Door to Groin to total IVT transport groin recanalisation
TEMPiS 107 170 45 322min (5:22h) Helicopter 115 20 17 25 45 222min (3:42h)
-100 min 13. 23 November 2017
Improvement of outcome dependend on time to reperfusion 13. 24 November 2017
TEMPiS Team