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ORIGINAL ARTICLE   Free accessfree

Minerva Anestesiologica 2021 October;87(10):1091-9

DOI: 10.23736/S0375-9393.21.15455-0


language: English

Emergently planned exclusive hub-and-spoke system in the epicenter of the first wave of COVID-19 pandemic in Italy: the experience of the largest COVID-19-free ICU hub for time-dependent diseases

Arturo CHIEREGATO 1 , Giacomo VERONESE 2, Francesco CURTO 1, Matteo ZANIBONI 1, Francesca FOSSI 1, Fabrizio ZUMBO 1, Carla SCATTOLINI 1, Christian COMPAGNONE 1, Beatrice M. ALBERTI 1, Camelia BACIU 1, Lavinia BERGESIO 1, Stefano M. CARENINI 1, Giorgio CHEVALLARD 1, Cristiana CIPOLLA 1, Alessandra C. FORMENTANO 1, Alessandro GUIDI 1, Francesco MASSIMO 1, Irene GALLUCCIO 1, Silvano PAGANI 1, Rosaria PAPARONE 1, Federico POZZI 1, Lorenzo PRESSATO 1, Enrica PUGNETTI 1, Mauro RIGANTI 1, Francesco RUGGIERI 1, Fernanda TAGLIAFERRI 1, Gabriele TRINCHERO 1, Emanuele VASSENA 1, Gabriele BASSI 3, Riccardo GIUDICI 3, Marco SACCHI 4, 5, Osvaldo CHIARA 6, 7, Elio C. AGOSTONI 8, Giacomo GRASSELLI 9, 10, Roberto FUMAGALLI 2, 3

1 Neurointensive Care Unit, Niguarda Hospital, Milan, Italy; 2 School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; 3 Department of Anesthesia and Intensive Care 1, Niguarda Hospital, Milan, Italy; 4 SOREU, Niguarda Hospital, Milan, Italy; 5 Local Organ Procurement Organization, Niguarda Hospital, Milan, Italy; 6 School of Medicine and Surgery, University of Milan, Milan, Italy; 7 Trauma Team, Niguarda Hospital, Milan, Italy; 8 Stroke Unit, Niguarda Hospital, Milan, Italy; 9 Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; 10 Department of Anesthesia and Intensive Care, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

BACKGROUND: Lombardy was the epicenter in Italy of the first wave of COVID-19 pandemic. To face the contagion growth, from March 8 to May 8, 2020, a regional law redesigned the hub-and-spoke system for time-dependent diseases to better allocate resources for COVID-19 patients.
METHODS: We report the reorganization of the major hospital in Lombardy during COVID-19 pandemic, including the rearrangement of its ICU beds to face COVID-19 pandemic and fulfill its role as extended hub for time-dependent diseases while preserving transplant activity. To highlight the impact of the emergently planned hub-and-spoke system, all patients admitted to a COVID-19-free ICU hub for trauma, neurosurgical emergencies and stroke during the two-month period were retrospectively collected and compared to 2019 cohort. Regional data on organ procurement was retrieved. Observed-to-expected (OE) in-ICU mortality ratios were computed to test the impact of the pandemic on patients affected by time-dependent diseases.
RESULTS: Dynamic changes in ICU resource allocation occurred according to local COVID-19 epidemiology/trends of patients referred for time-dependent diseases. The absolute increase of admissions for trauma, neurosurgical emergencies and stroke was roughly two-fold. Patients referred to the hub were older and characterized by more severe conditions. An increase in crude mortality was observed, though OE ratios for in-ICU mortality were not statistically different when comparing 2020 vs. 2019. An increase in local organ procurement was observed, limiting the debacle of regional transplant activity.
CONCLUSIONS: We described the effects of a regional emergently planned hub-and-spoke system for time-dependent diseases settled in the epicenter of COVID-19 pandemic in Italy.

KEY WORDS: COVID-19; Stroke; Wounds and injuries; Tissue and organ procurement

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