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Sistema de Telemedicina y TAC para la diagnostico y tratamiento del pre-hospitalario del paciente con Accidente Cerebro Vacular ACV
VIMED® STEMO
El concepto de STEMO se desarrolla para la optimización del cuidado en el transporte prehospitalario. Demuestra ventajas claras sobre el trasnpòrte estándar "Convencional", bajo condiciones de la operación verdadera del rescate. VIMED® STEMO es un vehículo especialmente equipado para el manejo de emergencias Cerebro-Vasculares con la incorporacion de Equipo Medico de Ultima Generacion "TAC" Tomografia Axial Computarizada y la telemedicina. Con medidas diagnóstico-terapéuticas completas para pacientes agudos durante el transporte se pueden iniciar inmediatamente dentro de la unidad movil.
CODIGO ICTUS MADRID. Atención a pacientes con ictus en la Comunidad de Madrid. pdf Gratis emssolutionsint.blogspot.com/2018/07/codigo-ictus-madrid-atencion-pacientes.html
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http://emssolutionsint.blogspot.com/2016/07/medidas-de-actuacion-en-el-ictus-o.html
http://emssolutionsint.blogspot.com/2016/07/medidas-de-actuacion-en-el-ictus-o.html
Prevención, identificación y actuación en el ICTUS. Tiempo es cerebro. Llama al 061 http://emssolutionsint.blogspot.com/2018/07/medidas-de-actuacion-en-el-ictus-o.html
Principios de los Cuidados del Accidente Cerebrovascular, ICTUS Isquemico emssolutionsint.blogspot.com/2011/04/cadena-de-supervivencia-por-ictus.html
Guía de información al paciente con ICTUS "Guía de información al paciente con ICTUS"
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Prevención, identificación y actuación en el ICTUS. Tiempo es cerebro. Llama al 061 emssolutionsint.blogspot.com/2018/07/prevencion-identificacion-y-actuacion.html
CODIGO ICTUS MADRID. Atención a pacientes con ictus en la Comunidad de Madrid. pdf Gratis
emssolutionsint.blogspot.com/2018/07/codigo-ictus-madrid-atencion-pacientes.html
emssolutionsint.blogspot.com/2018/07/codigo-ictus-madrid-atencion-pacientes.html
Guia de atencion al ICTUS. Servicio Canario de Salud. España PDF Gratis emssolutionsint.blogspot.com/2018/06/guia-de-atencion-al-ictus-servicio.html
Ambulancia Neuro-Protegida del Mundo. En el estadio Boca en Argentina
emssolutionsint.blogspot.com/2015/07/primer-estado-neuro-protegido-del-mundo.html
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Ambulancia especializada en accidentes cerebrovasculares contiene un tomógrafo portátil CereTom para comenzar antes el tratamiento
by on jun 6, 2012 • 3:20 am
Relacionado: Ambulancia Neuro-Protegida del Mundo. En el estadio Boca en Argentina http://emssolutionsint.blogspot.com.es/2015/07/primer-estado-neuro-protegido-del-mundo.html
NeuroLogica y MEYTEC de Alemania han desarrollado una ambulancia especializada en accidentes cerebrovasculares, llamada VIMED STEMO, que contiene un tomógrafo/escáner portátil y un laboratorio en el punto de atención para el diagnóstico y el inicio del tratamiento casi-instantáneo en pacientes con apoplejías. El sistema utiliza soluciones de telemedicina de MEYTEC y el escáner/TAC portátil CereTom de NeuroLogica.
El VIMED STEMO integra una suite pre-clínica, totalmente operativa, de atención al ictus, comparable a las encontradas en los hospitales especializados en accidentes cerebrovasculares. El CereTom a bordo es un escáner/TAC de 8 cortes que permite obtener imágenes multimodales con angiografía/TC y perfusión/TC en combinación con un tiempo de exploración rápido. Las imágenes y otros datos pueden ser transmitidos a través de conexiones cifradas de 3G, 4G y por satélite a las salas de emergencia o centros de trauma.
Además de estar bien equipada, la ambulancia lleva el mejor equipo médico hasta su puerta si usted está sufriendo de un accidente cerebrovascular, incluyendo un paramédico, un médico de accidentes cerebrovasculares y un neurorradiólogo. En conjunto, esto permite una atención hiper-aguda del ictus, incluido el tratamiento trombolítico, tan pronto como sea posible y mucho antes de la llegada a un hospital. No hay información sobre el costo del servicio por viaje.
Por supuesto, la pregunta sigue siendo si este tipo de atención hiperaguda se traduce en mejores resultados para los pacientes, pero las compañías ya han llevado a cabo un ensayo aleatorio que proporciona algunas pistas. Asignaron al azar 100 pacientes, a la ambulancia, especializada o a la atención de emergencia habitual. Como era de esperar, el tratamiento pre-hospitalario del accidente cerebrovascular redujo considerablemente el tiempo medio desde la alarma a la decisión de la terapia (35 min frente a 76) con ganancias similares en los tiempos desde la alarma hasta el fin de la TC, y desde la alarma hasta el final de los análisis de laboratorio, y hasta la trombólisis intravenosa para los pacientes elegibles con accidente cerebrovascular isquémico.
No hubo una diferencia sustancial en el resultado neurológico entre los grupos, sin embargo, el estudio no fue diseñado para detectar una diferencia y el seguimiento fue relativamente corto. Se demuestra que el diagnóstico pre-hospitalario y el tratamiento de accidentes cerebrovasculares es factible y puede reducir el tiempo transcurrido hasta el tratamiento a un nivel que antes era inalcanzable. El VIMED STEMO está incrustado en el sistema de servicio de emergencia de Berlín.
Por supuesto, la pregunta sigue siendo si este tipo de atención hiperaguda se traduce en mejores resultados para los pacientes, pero las compañías ya han llevado a cabo un ensayo aleatorio que proporciona algunas pistas. Asignaron al azar 100 pacientes, a la ambulancia, especializada o a la atención de emergencia habitual. Como era de esperar, el tratamiento pre-hospitalario del accidente cerebrovascular redujo considerablemente el tiempo medio desde la alarma a la decisión de la terapia (35 min frente a 76) con ganancias similares en los tiempos desde la alarma hasta el fin de la TC, y desde la alarma hasta el final de los análisis de laboratorio, y hasta la trombólisis intravenosa para los pacientes elegibles con accidente cerebrovascular isquémico.
No hubo una diferencia sustancial en el resultado neurológico entre los grupos, sin embargo, el estudio no fue diseñado para detectar una diferencia y el seguimiento fue relativamente corto. Se demuestra que el diagnóstico pre-hospitalario y el tratamiento de accidentes cerebrovasculares es factible y puede reducir el tiempo transcurrido hasta el tratamiento a un nivel que antes era inalcanzable. El VIMED STEMO está incrustado en el sistema de servicio de emergencia de Berlín.
Comunicado de prensa: NeuroLogica Corporation Announces Partnership with MEYTEC GmbH…
Mas información: Project STEMO…
Lancet Neurology: Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial…
Tema relacionado
AMBULANCIAS:
Primer EstadIo Neuro-Protegido del Mundo. Argentina
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Mobile Stroke Units Designed to Quickly Reach, Treat Patients
by EMSWORLD
News Nov 27, 2017
Time is brain. That’s the mantra of physicians who warn that those with stroke symptoms need immediate medical attention.
The sooner a stroke is treated, the greater the possibility of saving brain cells and achieving recovery.
Now, about a dozen hospitals nationwide are evaluating and treating patients faster with mobile stroke units. These special ambulances are equipped with a CT scanner, an imaging technician, a paramedic, a nurse, a neurologist or telemedicine connection to a neurologist, and the clot-busting medicine tissue plasminogen activator, known as tPA.
In an ischemic stroke—the most common type, caused by a clot blocking blood flow to the brain—tPA can improve recovery chances if administered within three hours, or up to 4 ½ hours for some patients.
“Time is so critical,” said James Grotta, M.D., director of stroke research in the Clinical Innovation and Research Institute at Memorial Hermann-Texas Medical Center in Houston, where the first mobile stroke unit was launched in the United States in 2014.
“It gets it all moving faster,” Grotta said. “The idea is to get more treated in that first hour.”
The concept began in Germany, where Grotta visited in 2012 to learn about that country’s mobile stroke response. Then he oversaw the start of the mobile stroke unit in Houston.
When stroke is suspected based on a 911 call, the mobile unit is dispatched within a 7- or 8-mile radius, allowing evaluation of the patient at the scene. Or, the mobile unit may meet a patient halfway after transport in a regular ambulance.
In some cases, the patient may start feeling better and it’s determined a stroke isn’t occurring, or medical officials may suspect a hemorrhagic stroke, a less common type that occurs when a vessel ruptures and bleeds into the brain.
For those diagnosed with an ischemic stroke, tPA treatment can commence. Another advantage is quicker triage for patients needing a procedure to remove the clot using a stent retriever, Grotta noted.
Approximately one-third of stroke patients reached by a mobile stroke unit get treated in the first hour after stroke symptoms start, compared with less than 1 percent who are treated at the emergency room, Grotta said.
“It starts with the patient calling 911,” he said. “Recognizing, and not ignoring, the symptoms of a stroke is critical.”
Symptoms can include face drooping, arm weakness and speech difficulty. Approximately 800,000 Americans each year have a stroke, the nation’s fifth-leading cause of death.
The University of California, Los Angeles launched a mobile unit in September after working closely with local government officials to address regulatory issues, said May Nour, M.D., Ph.D., an interventional neurologist and medical director of the UCLA Arline and Henry Gluck Stroke Rescue Program.
Although the benefits and cost-effectiveness must be scientifically proven before there is wider use, Nour hopes to soon have enough mobile units to cover all of Los Angeles County.
“Anything that’s new takes time,” she said. “We are doing the tough task of banding together nationally and internationally to evaluate the evidence.”
A study in The Lancet Neurology in September 2016 did not find statistically better outcomes in pre-hospital treatment versus conventional treatment. But the study, limited by a small number of patients, suggested mobile unit treatment might lead to improved results. Researchers said a large-scale trial is needed.
Grotta’s team is conducting a large randomized trial through PCORI, the Patient-Centered Outcomes Research Institute. Along with Houston, mobile stroke units in Memphis, Tennessee, and Denver, Colorado, are participating to examine patient outcomes during weeks when a mobile unit is dispatched versus other weeks of standard treatment. A separate analysis will look at the costs of implementing a mobile stroke unit versus the cost savings that result from better outcomes for patients.
The price for a mobile stroke unit ranges from $600,000 to $2 million, according to the consortium PRESTO, the PRE-hospital Stroke Treatment Organization. Making a physician available through telemedicine rather than in person can save money in staffing and has been determined to be just as accurate, Grotta said.
Hospitals usually pay for the units through philanthropy because insurance reimbursements don’t cover the startup costs and cover little of the clinical activities performed in the unit, he said, but more research may show clear cost benefits.
Nour believes cost-effectiveness ultimately will be proven with the positive impact on patients’ lives.
“Proving cost-effectiveness will allow this innovative stroke care delivery platform to be accessible to all stroke survivors by changing the infrastructure of prehospital care,” she said. “But we need to show that.”
If you have questions or comments about this story, please email editor@heart.org .
For more information on hospitals utilizing mobile stroke units across the country, click here.
Source
AMERICAN HEART ASSOCIATION NEWS
http://www.meytec.com/download/datasheets/db-vimed-stemo-en.pdf
The STEMO concept is developed for optimization of the prehospital stroke care. It shows clear advantages over the standard channel of supply, under conditions of the real rescue operation. VIMED® STEMO is a specially equipped emergency vehicle with comprehensive telemedicine and medical equipment. The full diagnostic and therapeutic measures for acute stroke patients can be immediately initiated locally. For this purpose the STEMO vehicle is equipped with a mobile computer tomography (CT).
All examination measures with the CT-scanner and the patient transport to the next stroke unit happens directly (compared to the other concepts) in the STEMO-emergency vehicle. The radiological DICOM-images are transmitted into the diagnostic location by means of an encrypted VPN-tunnel via fail-safe UMTS and LTE solutions or a satellite. Optionally, the radiological images can also be evaluated directly on the medical findings monitor installed according to the German Radiology Regulation (RöV) locally. Intelligent automatic switching between the available mobile networks provides VIMED® STEMO a high level of independence from the quality of the transmission networks. The STEMO solution is a mobile clinic with multimodal tele-consultation equipment for the complete emergency care of acute patients. Constructed on the strict rules of rescue services the STEMO vehicle is today used under real conditions with real patients in the Berlin area. The patient location could be achieved here on average in 16 minutes to bring the stroke patients within 52 minutes (from the emergency call) to the next stroke unit. All lysable patients receive a treatment initiated directly in the STEMO-vehicle.
All examination measures with the CT-scanner and the patient transport to the next stroke unit happens directly (compared to the other concepts) in the STEMO-emergency vehicle. The radiological DICOM-images are transmitted into the diagnostic location by means of an encrypted VPN-tunnel via fail-safe UMTS and LTE solutions or a satellite. Optionally, the radiological images can also be evaluated directly on the medical findings monitor installed according to the German Radiology Regulation (RöV) locally. Intelligent automatic switching between the available mobile networks provides VIMED® STEMO a high level of independence from the quality of the transmission networks. The STEMO solution is a mobile clinic with multimodal tele-consultation equipment for the complete emergency care of acute patients. Constructed on the strict rules of rescue services the STEMO vehicle is today used under real conditions with real patients in the Berlin area. The patient location could be achieved here on average in 16 minutes to bring the stroke patients within 52 minutes (from the emergency call) to the next stroke unit. All lysable patients receive a treatment initiated directly in the STEMO-vehicle.
Telemedical system for the pre-hospital diagnosis and therapy of acute stroke patients
STEMO is a principally new stroke care concept, that has closed previous gaps in stroke care practice with the help of specially developed telemedicine solutions and optimization of the care processes. The central objective is to optimize the treatment of acute stroke patients in metropolitan environments, especially for the benefit of the patient. The central idea of STEMO solution is to bring forward the expensive diagnostic and therapeutic measures from the clinical / inpatient (stroke unit / neurology department) in the pre-hospital / mobile-ambulance sector (STEMO vehicle). The engineers of the project consortium STEMO have created a full size emergency vehicle with an integrated mobile computer tomograph (CT), providing teleradiology diagnostics, modern laboratory equipment, electronic treatment documentation and telemedical networking. The overall solution is the result of the collaboration with Charité University Medical Center Berlin, Berlin Fire Department, MEYTEC GmbH Information System and Thermo Fisher Scietific BRAHMS biomarker.
The supply concept STEMO, embodies modern technology and telemedicine solutions that meet the most stringent standards of the rescue service. The success of STEMO is not only confirmed with the results of the associated clinical trial PHANTOM-S (pre-hospital acute neurological therapy and optimization of medical care in stroke patients), but also the positive response from the real emergency missions.
The key results of the PHANTOM-S trial with more than 7.000 enrolled patients show that the lysis rate in the Berlin area has been raised by 50% within the 21 months, while starting the thrombolytic therapy directly in STEMO rescue vehicle with special equipment, the patient is then transported to the appropriate acute center. The treatment rate of stroke patients has been raised from 21 to 31%. Comparing the care of stroke patients in the STEMO supply concept with the supply on the usual supply route, the patients were treated 25 minutes earlier with STEMO. The special rescue algorithm increases the recognition rate of strokes directly from the emergency call center to 53% (hit ratio 60%).
A specially trained three-man team has at their disposal the most advanced laboratory technology, teleradiology applications and a mobile CT scanner in the treatment room of STEMO unit. The mobile treatment room with the CT scanner is shielded from X-rays, so that both the team and the people outside of the mobile treatment room are protected from any radiation.
The use and assimilation of the stroke care concept STEMO, is accompanied by the close cooperation with the experts from the Charité Berlin. Different modifications of the STEMO solution can be directly purchased as VIMED® STEMO from MEYTEC GmbH Medizinsysteme.
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