Thrombectomy in Rural Areas the „Flying Interventionist“ Project
Total Page：16
File Type：pdf, Size：1020Kb
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.