On June 12, 2019, from 12:30 to 13:00, Beijing time, Medebound HEALTH conducted a multi-disciplinary team consultation for a 54-year-old male patient who had been unconscious for two hours between Sun Yu Zheng, director of neurology at New York Presbyterian Hospital, local ICU specialist, local anesthesiologist ECMO specialist, attending doctors and patient’s family.
Video consultation
Head doctor of the patient: I have one more question to ask. This sub-low-temperature treatment is now 72 hours, do we need to further control his temperature between 34-36 degrees?
Attending ICU specialist: The treatment temperature of the brain in its realization stage is always lower than the higher temperature, and hopefully it is bigger. A rise in body temperature to 37-38 degrees is not good for the patient.
Professor Sun Yu Zheng, American neurology specialist: That’s right.
Attending ICU specialist: Since we need treatment, it doesn’t need to be so low now. I think 35 degrees is a relatively safe temperature.
ECMO specialist in the Chinese Anesthesiology Department: Brain protection is usually useful for the first three days, but the latter is actually of little value. For the latter, the patient's brain function needs to be evaluated by returning it to the normal body temperature.
Professor Sun Yu Zheng, American neurology specialist: Yes, brain protection is most useful for 72 hours.When evaluating, the temperature should be raised to more than 36 degrees.
This was a conversation among medical professionals across space, time, and disciplines.
On June 12, 2019 from 12:30 to 13:00, Beijing time, Medebound HEALTH conducted a multi-disciplinary team, MDT consultation for a 54-year-old male patient who had been unconscious for two hours between Sun Yu Zheng, director of neurology at New York Presbyterian Hospital, attending ICU specialist, attendinganesthesiologist extracorporeal membrane oxygenation, ECMO specialist, attending doctors and patient’s family.
Patient's medical records
June 8th
At 7:30, the patient's family found him lying on the floor and couldn't breathe. Cyanosis of the face and mouth, no physical twitch, incontinence of the stool, emergency CPR treatment by the family, relieved the patient of cyanosis, but still unconscious. After a series of CPR and balloon-aid ventilation tests, ECG showed ventricular arrest and dilated pupils. Finally, organ-supported treatments such as ECMO, LABP, CRRT, ventilator, and vascular active drugs are performed.
June 12th
The patient's vital signs are unstable, coma, no spontaneous respiration, tracheal intubation, auxiliary ventilation, bilateral pupil diameter is about4-5 mm, and reflection to light is lost.
Looking at the patient lying in the ICU, the patient's family felt helpless because his eyes were closed, and there was no movement or expression. So they turned their eyes to Medebound, to advanced American medical technology, to seek advice from renowned American doctors.
On June 10, the patient's family sent a request for video consultation to Medebound AP Medical Center to help evaluate the patient's condition and seek better treatment advice from American doctors.
It took only two days for Medebound to successfully organize multidisciplinary video sessions with experts from China and the United States at the request of the patient's family. In the short period of two days, the work involved selecting, appointing Chinese and American experts, collecting, organizing, translating, and arranging video consultations. In the end, the MDT team was formed by top U.S. neurologist, attending ICU specialist, and attending anesthesiologist, and it was conducted remotely simultaneously from Chengdu, Shenzhen, and New York on June 12.
Video consultation excerpt
Professor Sun Yu Zheng, American neurology specialist: I've got the whole picture of the patient, he’s in a serious condition. If the heart stops beating and blood is not supplied to the back of the brain, the brain will suffer irreversible brain damage after a long time.
The general situation of the patient I see now is the inability to breathe on its own, pupils are dilated, no reflection of light, and there may be no reflection of the medulla oblongata. I am not very sure about this. So now we're talking about two possibilities, one that is reversible, that there's no formal brain death yet, which allows us to do some brain rehabilitation. Another possibility is that hypoxia lasts too long, leading to the death of medulla cells in the brain, which is irreversible. How do you diagnose brain death? Diagnosis is based on three main requirements: 1. No brain function; 2. No neuro reflection of the medulla; 3. No respiratory function. If all three of these have been confirmed, it's proof that the patient's brain is completely dead.
Attending ICU specialist: In view of the current situation of this patient, let me share my thoughts. Until we can accurately judge that his brain is dead, we should continue treatment for him. I'd like to include a few things for his current treatment: 1. The brain needs to focus on sub-low-temperature therapy, and it needs to make sure that the temperature of the brain is not too high, and the temperature of the whole body is not too high, because there are CRRT, ECMO, and I want it to be between 35 and 36 degrees.
Professor Sun Yu Zheng, American neurology specialist: Yeah, the temperature for brain damage is 35 to 36 degrees.
All right. The ICU specialist spoke very comprehensively just now, and the methods they are using now are based on the patient's requirements, they are still maintaining his life. In the end, the thoughts of the ICU specialist were similar to mine. His heart function, his chances of recovery, his chances of survival are very slim, so the chances of brain resuscitation are very slim too. Now, as the ICU specialist said, if the patient’s family wants to prolong the patient’s life, it is up to the family to decide. In the end, the family still has to make a decision. Whether it is brain dead or not, the hospital needs to identify this according to the criteria for brain death. So what I'm hearing now is that families may still want some miracle to happen, and maybe they'll have to come back in a couple of days to make a decision whether or not they're here for the final evaluation of brain and heart conditions. If it's brain death, I'm sure the hospitals are well aware of the criteria for brain death. Based on what I'm seeing and what he's saying, it's very unlikely that the patient will recover. This is my opinion. Now it's okay if you postpone it for a few more days because the hospital is also doing its best in the light of your family's situation, but after a few days, the family will definitely need to come to decide whether to postpone it or not. By then we can do the brain death test.
Attending ICU specialist: According to the current situation, the heart condition is not beating at all, even though if you want to support it for a long time, it is not possible.
Professor Sun Yu Zheng, American neurology specialist: It won’t last long.
Attending ICU specialist: Because blood clots will grow soon. So this is also a difficult thing.
Professor Sun Yu Zheng, American neurology specialist: If the heart doesn't beat, the brain is less likely to survive.
The multi-disciplinary treatment model (MDT) is a leading treatment model widely revered in modern international healthcare. While breaking down the barrier between disciplines, MDT can effectively promote the construction of disciplines and use existing treatment methods to select the most appropriate treatment for patients.
MDT originated in the United States in the 1990s.In the United States, some important oncology treatment centres have established MDT workflows. The National Cancer Network (NCCN) published guidelines for the diagnosis of tumours, which are medical guidelines derived from the review of the MDT model.
In Europe, where health centres are relatively concentrated, such as France, the United Kingdom, and Germany, the MDT model has become an important part of the hospital health system, enforced by the state.
Although the MDT has been implemented in many countries for a long time, it has not been properly implemented and has not become a regular practice for doctors. Medebound HEALTH has arranged a multidisciplinary consultation with top U.S. doctors and Asian experts to examine patients' conditions and provide the best treatment for their families.
About Medebound HEALTH Medebound HEALTH (https://www.medeboundhealth.com) is a global tele-health company with the focus on connecting overseas patients/physicians with US doctors and advanced treatment methods. This is achieved by creating a proprietary bi-lingual HIPAA-compliant tele-health platform, which facilitates secure medical imaging/records translation, transferring and tele-consultations; and by a robust supply chain for advanced medicine. With this highly differentiated physician network and bilingual IT platform and a strong execution team, Medebound has gained significant market traction with customers including major hospital centers and insurers in Asia. Through Medebound HEALTH's cross-border teleconsultation platform, cancer patients in the eastern world can consult US-based cancer specialists with a few clicks, and patients can also easily access advanced medicines via our pharmaceutical logistics system.
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