Establishment of the First Mobile Telemedicine for Aortic Emergencies in Japan

Abstract

Introduction - Quick and adequate decision-making is crucial to save patients with aortic emergencies including aortic dissection and aneurysm rupture. Preparing the devices to adapt to each patient’s anatomy is another crucial componet in the era of endovascular treatment. Surgical teams for aortic emergencies and special facilities, such as a hybrid operation room, are limited resources in rural areas. Telemedicine with high-resolution graphic data is thought to play significant roles in emergency medicine for cardiovascular emergencies, especially acute aortic syndrome. Methods - Asahikawa Medical University Hospital, which is locates in the centre of Hokkaido, introduced a mobile telemedicine system named JOIN, and created a cloud network of telemedicine that connects 6 local core hospitals, covering a 150 km range from Asahikawa. The JOIN application can transmit PACS (picture archiving and communication system) images such as CT scan and MRI as high-definition graphic data. Users can magnify an interesting area of the images and measure the length or angle of subjects appearing on users’ smartphones or tablet devices(Figure). We have been testing this mobile telemedicine system for acute cardiovascular emergency since October 2016. Results - Over 18 months, we have performed 63 consultations using this JOIN system, including 15 acute aortic dissections, 7 impending ruptures of thoracic aortic aneurysms, 4 ruptured abdominal aortic aneurysms(AAAs), 7 impending ruptures of AAAs, 5 cases of acute limb ischaemia, 3 cases of thrombosis or dissection of superior mesenteric artery, and other conditions. Among the 63 cases, 32 cases underwent emergency treatment and 16 cases were treated by endovascular treatment or hybrid therapy. Focusing on ruptured AAA, all four patients in the telemedicine system (TM group) were treated by endovascular aneurysm repair (EVAR), whereas 83% of the 18 AAA ruptures patients who were admitted without use of telemedicine (non-TM group; years 2011 Jan∼2018 March) were treated by EVAR. The door to operation time was 6∼70 min (median 11 min) in the TM group and 39∼211 min (median 88 min) in the non-TM group (p<0.05). The hospital death rate in the TM and non-TM groups were 0% and 16.7%, respectively. The questionnaire completed by medical staff revealed that communications among surgeons, anaesthesiologists, clinical engineers, and nurses have improved. Conclusion - Preliminary results suggest the following benefits:1)This telemedicine system can create time not only to prepare the devices and operating room but also to discuss and decide the treatment strategy before patient arrival.2)This telemedicine system reduces the door to operation time, which may contribute to improved clinical outcomes.3)The communication among medical staff is improving through the use of this system, which positively impacts the surgeon’ education and medical safety.