Multi-disciplinary team MDT with cross-border experts to rescue a patient from Coma
- Medebound HEALTH
- Jul 7, 2019
- 9 min read
Updated: Nov 27
When a loved one suddenly collapses and stops breathing, the world seems to freeze. For this family, what began as a normal morning turned into a nightmare their 54-year-old husband and father was found unconscious on the floor, unable to breathe, his face turning blue. Despite emergency CPR, advanced life support, and powerful machines keeping his heart and lungs alive, he never woke up.
As hours turned into days in the ICU, the family was left with only one haunting question:
Is there still hope or has the brain already suffered irreversible damage?
Faced with uncertainty and rising fear, they turned to Medebound HEALTH to seek answers beyond borders reaching out to top U.S. neurologists and critical care experts for clarity, truth, and expert medical judgment. This led to an urgent multi-disciplinary team (MDT) consultation between Chinese and American specialists to determine the patient’s real condition and whether life could still be saved.
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, 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, 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: Emergency at Home: The Moment Everything Changed
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 12 — Condition Worsens
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.
A Family’s Desperation Turns Into Hope
Professor Sun, 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, 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, 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, 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
About Medebound HEALTH: Since 2016, we've helped thousands of affluent families mostly from Asia get personalized cancer remote second opinions from the top 1% of US hospitals through simple written opinion or video calls. These are the same top doctors trained or active at top hospitals such as MD Anderson, Mayo Clinic, Memorial Sloan Kettering and Johns Hopkins, etc, you will get their expertise, their treatment suggestion, and their guidance - all from your home. No matter where you live, world-class cancer care is just a few steps away.
How Medebound HEALTH Supports Your Cancer Treatment Journey
Medebound HEALTH bridges the gap between you and the best US cancer experts, whether you’re seeking a virtual consultation or planning your medical travel. Our services include:
Connecting you with leading sarcoma doctors at MD Anderson, Memorial Sloan Kettering Cancer Center (MSKCC), and other top hospitals.
Assisting with both written and video second opinions, as well as on-site appointments for in-person treatment.
Compared to contacting the hospital’s international department directly, Medebound HEALTH offers a more efficient appointment process:
Second opinions can be completed within 1-2 weeks.
On-site appointments can be arranged within 3-4 weeks.
Coordinating comprehensive support for travel logistics, including visa assistance, accommodation arrangements, and interpreter services.
For on-site appointments, the hospital’s international department provides medical translation services, while Medebound HEALTH offers additional daily life translation support to help you feel comfortable throughout your stay.
Providing continuous care coordination to ensure smooth communication between your local doctors and US specialists, so your treatment plan is clear and seamless.
Important Considerations:
Insurance Coverage: Check with your insurance provider regarding coverage for second opinion consultations, as many may not cover the cost.
Second Opinion Limitation: U.S. second opinion consultations are for reference purposes only. The physician-patient relationship is not formed with your remote physician. Remote consultations differ from in-person visits and are subject to limitations due to lack of direct in-person examination. As such you will need to understand Medebound HEALTH and the U.S. doctor are not liable for any treatment decisions made based on the second opinion, and accept the risks of relying on any information provided under this agreement. You will need to sign an agreement to confirm that you voluntarily request this service and understand its limitations.
Timeliness: Getting a second opinion early in your treatment journey, ideally before starting treatment, can be beneficial.
Comparison: Getting a U.S. Second Opinion
Feature | Travel to the U.S. | Apply Directly to U.S. Hospital | Medebound HEALTH |
Doctor Level | Random assignment | Junior faculty | Top specialist matched to your case |
Timeline | 3–6 months + travel time | 3–6 months wait | As fast as 5 days |
Cost | $30,000+ (travel + consultation) | $3,000–$6,000 + self-paid translation | $2,000–$5,000 (all-inclusive) |
Consultation Format | In-person only | Limited or no remote access | Written report + video consultation |
Language Support | Minimal | None | Full medical translation included |
Follow-up Support | Additional appointments needed | Not included | 2–3 follow-up Q&A included |
Convenience | Requires international travel | Manual coordination | Fully managed proces |
Conclusion: Taking Control with Medebound HEALTH and US Expertise
Facing sarcoma can be daunting, but with Medebound HEALTH, you don’t have to navigate it alone. Whether you start with an online second opinion or plan a full medical tour to the USA, you gain access to the most advanced treatments and compassionate care.
You can take charge of your treatment with expert guidance, clear options, and the reassurance that sarcoma doesn’t stand a chance against the power of US cancer treatment.
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Disclaimer:
We strive to maintain the accuracy and provide regular updates for the treatment information described in this article. However, treatment outcomes may vary between individuals. The information provided here is not intended as a diagnostic or treatment recommendation and should not replace the careful evaluation and advice of your attending physician
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