Thrombectomy in rural areas the „flying interventionist“ project

Nov 13, 2017 - 13. November. 2017. 2. Telemedicine in TEMPiS ... 13. November. 2017. 3. Stroke patients in the network. 4 109. 4 649 .... •Ready at all times.
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Thrombectomy in rural areas the „flying interventionist“ project États généraux de l‘AVC 2017 – Lyon Gordian Hubert www.tempis.de

Klinikum rechts der Isar Abteilung für Neuroradiologie

13. November 2017

Foundation of the telestroke network TEMPiS

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Telemedicine in TEMPiS

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Stroke patients in the network 11 000

10 039

10 000

9 411 8 618

9 000 8 000

7 207

7 000 6 000 5 000

4 649

4 894

4 786

2005

2006

5 832

5 750

5 987

2008

2009

2010

7 616

6 374

5 216

4 109

4 000 3 000 2 000 1 000 0 2003

2004

2007

2011

2012

2013

2014

2015

2016

13. 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

3 000 2 000

2 682

2 844 2 837

3 216 3 187 3 062

1 928

1 000 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

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Helsinki and Uusimaa 1.56 mio (inhabitants) 9096km² (area) 172/km² (population density)

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TEMPiS network 1.94 million (inhabitants) 14992km² (area) 129/km² (population density)

GJ Hubert, et al Stroke 2016

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How to implement mechanical thrombectomy in rural areas?

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Problematic Triad

High expertise

Time critical

hands on

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Improvement of outcome dependend on time to reperfusion

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TEMPiS Data

Onset - IVT Delays (min)

107

IVT transport

transport

170

Door to groin

Groin to recanalisation 45

total

322min (5:22h)

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Suspected stroke patients: Options for prehospital decision-making

Mothership model

Drip & Ship model

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Prehospital decision-making Is there a third option?

?

Mothership model

Drip & Ship model

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Drip and Ship Model Primary Stroke Center

Comprehensive Stroke Center

Primary Stroke Center

Primary Stroke Center

Patient

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Mothership Model Primary Stroke Center

Comprehensive Stroke Center

Primary Stroke Center

Primary Stroke Center

Patient

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Endovascular Treatment on Demand

In the TEMPiS model, the mothership becomes a carrier for flying interventionalists

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Drip and Demand (Carrier Model)

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Comprehensive Stroke Center

Primary Stroke Center

Flying Interventionalist Primary Stroke Center

Primary Stroke Center

Patient

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Drip and Demand (Carrier Model) A new option for prehospital triage

Carrier model

Mothership model

Drip & Ship model

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Helicopter

Neurointerventionalists

Spoke hospital

•Close to hospital •Ready at all times

• Experienced Interventionists • 24/7 • Trained to work at all angiography suites

•Helicopter airport •Angiography suite or cardiac angio •24/7-Anesthesie •(Tele-)Stroke Unit

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Schwandorf

Burglengenfeld

Cham

Cham

Participating hopsitals Regensburg

Regen StraubingBogen

Klinik der Universität Regensburg 4 am Bezirksklinikum

Zwiesel Straubing Freyung-Grafenau

Kelheim

c

Kelheim DingolfingLandau

Landshut

Freising

Deggendorf

Passau

Eggenfelden

Vilsbiburg

Freising Rottal-Inn

Erding

Dachau

Mühldorf

Dachau

Pasing

Erding

2

Ebersberg 8

Mühldorf a. Inn

Altötting

Klinikum Harlaching Traunstein

Ebersberg München

Rosenheim Bad Tölz

Traunstein

Miesbach Rosenheim

Agatharied Bad Tölz Wolfratshausen

Bad Reichenhall Berchtesgadener Land

Passau

Rotthalmünster

c

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Time delays

Onset IVT TEMPiS

107

Helicopter

115

IVT transport

transport

Door to groin

170 20

17

25

Groin to recanalisation

total

45

322min (5:22h)

45

222min (3:42h)

-100 min

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Improvement of outcome dependend on time to reperfusion

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13. November 2017

TEMPiS Team

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