ORIGINAL ARTICLE   Free access

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

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, 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