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Minerva Anestesiologica 2021 Jun 08

DOI: 10.23736/S0375-9393.21.15455-0

Copyright © 2021 EDIZIONI MINERVA MEDICA

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


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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 re-designed 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; Hub-and-spoke; Neurosurgical emergencies; Stroke; Trauma; Organ procurement

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