The Telecardiology Revolution: From Emergency Management to Daily Clinical Practice.

AIMS: Telecardiology is one of the most widespread applications of telemedicine. We aimed to report the design and development of a telecardiology system in the sanitary district of Cosenza, one of the largest in Italy, with a complex orography, and healthcare reorganization needs, for the management of the emergency network and daily clinical practice. METHODS: Our telecardiology network connects 8 hospitals, 9 first aid centers, 20 local 118-EMS stations, 1 helicopter station, 8 hospital emergency departments, 59 hospital departments, and 3 catheterization laboratories. All data are centralized on a dedicated server, accessible from any location for real-time assessment. The quality, source, and timing of the electrocardiograms transmitted were evaluated. RESULTS: From October 2015 to December 2019, a total of 389,970 ECGs were transmitted. The quality of ECGs was optimal in 52%, acceptable in 42%, and poor in 6% of the cases. The number of poor-quality ECGs was only 3% in the last 2 years. Out of the total, 145,097 (37.2%) were transmitted from the emergency departments and 5318 (1.4%) from the 118-EMS. Of interest, a sizable part of the ECG was related to routine clinical practice, comprising 110,556 (28.3%) from the cardiology department and 79,256 (20.3%) from other noncardiovascular departments. Finally, the average reporting time was significantly decreased compared to reporting times without a telecardiology system (5-10 vs. 45-90 min). CONCLUSION: Our telecardiology system provides efficient cardiology assistance for all types, settings, and phases of cardiovascular diseases.

COVID-19 and STEMI: The role of telecardiology in the management of STEMI diagnosis during COVID 19 pandemic.

BACKGROUND: Telecardiology has the advantage of reducing patient's access time to the hemodynamics units. Data from literature show a reduction in ST-elevation myocardial infarction (STEMI) during COVID-19 pandemic. However, there is a low number of studies on the impact of telecardiology during the pandemic. METHODS: Our telecardiology system is composed of a Hub-and-Spoke network of hospitals and ambulances that ensures a rapid exchange of information allowing STEMI patients to be treated in the shortest time possible. We compared data from electrocardiograms (ECGs) transmissions and STEMI diagnosis collected between February and April 2020 with the data from the same period of 2019. RESULTS: Despite a significant reduction of ECGs transmissions from the telecardiology network was observed, the number of diagnosed STEMI during 2020 was stable and did not show any significant difference compared to 2019. The total number of STEMI diagnosis in the months under examination during 2019 were 47 out of 7463 ECGs (0.63%), while in 2020 were 48 out of 5797 ECGs (0.83%). CONCLUSIONS: The efficiency of our telecardiology system along with the low spread of the infection in our region contributed to maintaining the number of STEMI diagnosis and patient's care in line with the past even during the pandemic.

[Telecardiology: clinical, technical and social aspects. The project of the ASP of Cosenza, Italy]. / Telecardiologia: aspetti clinici, tecnici e sociali. Il progetto dell'ASP di Cosenza.

The aim of this paper is to present the project of telecardiology within the ASP of Cosenza, one of the largest provinces of Italy characterized by a particular orography, with difficult and inaccessible roads. The goal of this project is to manage the emergency more efficiently by reducing the time of intervention by bringing the patient not to the nearest hospital, but more importantly to the hospital more appropriately suited to better manage the cardiological emergency. This system also uses the most modern web-based interface technology protected by login and password. The project also provides the integration, supply and installation of advanced and modern central by ensuring efficient screening is carried out using monitors in all the coronary care units of the ASP of Cosenza, networking with electrocardiography of all the point of first medical contact and all the 118 emergency rescue service. By integrating all these procedures and information and making them available to any point in the hospital and territorial network, this project becomes not only a more efficient system for managing cardiac emergency but also a pathway that will guarantee increased care of patients from the onset of symptoms to discharge.

Mathematical model and minimal measurement system for optimal control of heated humidifiers in neonatal ventilation.

The control of thermo-hygrometric conditions of gas delivered in neonatal mechanical ventilation appears to be a particularly difficult task, mainly due to the vast number of parameters to be monitored and the control strategies of heated humidifiers to be adopted. In the present paper, we describe the heat and fluid exchange occurring in a heated humidifier in mathematical terms; we analyze the sensitivity of the relative humidity of outlet gas as a function of thermo-hygrometric and fluid-dynamic parameters of delivered gas; we propose a control strategy that will enable the stability of outlet gas thermo-hygrometric conditions. The mathematical model is represented by a hyper-surface containing the functional relations between the input variables, which must be measured, and the output variables, which have to remain constant. Model sensitivity analysis shows that heated humidifier efficacy and stability of outlet gas thermo-hygrometric conditions are principally influenced by four parameters: liquid surface temperature, gas flow rate, inlet gas temperature and inlet gas relative humidity. The theoretical model has been experimentally validated in typical working conditions of neonatal applications. The control strategy has been implemented by a minimal measurement system composed of three thermometers, a humidity sensor, and a flow rate sensor, and based on the theoretical model. Outlet relative humidity, contained in the range 90+/-4% and 94+/-4%, corresponding with temperature variations in the range 28+/-2 degrees C and 38+/-2 degrees C respectively, has been obtained in the whole flow rate range typical of neonatal ventilation from 1 to 10 L/min. We conclude that in order to obtain the stability of the thermo-hygrometric conditions of the delivered gas mixture: (a) a control strategy with a more complex measurement system must be implemented (i.e. providing more input variables); (b) and the gas may also need to be pre-warmed before entering the humidifying chamber.