First reorganization in Europe of a regional cardiac surgery system to deal with the coronavirus-2019 pandemic

Belluschi, Igor; Bonis, Michele De; Alfieri, Ottavio; Forno, Benedetto Del; Alamanni, Francesco; Polvani, Gianluca; Pompilio, Giulio; Roberto, Maurizio; Merlino, Luca; Troise, Giovanni; Triboldi, Alessandro; Credico, G. Di; Odinolfi, Fulvio Edoardo; Giamberti, Alessandro; Frigiola, Alessandro; Vincentiis, Carlo De; Menicanti, Lorenzo; Monaco, Fabrizio; Melisurgo, Giulio; Scandroglio, Anna Mara; Ambrosio, Alberto; Bottinelli, Elena; Castiglioni, Alessandro

doi:10.1093/ejcts/ezaa185

Cited by 9 publications

(9 citation statements)

References 7 publications

(7 reference statements)

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“…Although no official consensus statements were published by either academic or professional cardiac surgical societies, our survey reveals an almost uniform approach to indications for surgical procedures in Italy. It largely complies with that forwarded by the reorganization statement published by the Lombardy region [ 10 ]. When looking at the nationwide case mix during the lockdown, 4 points are worthy of a comment.…”

Section: Discussionsupporting

confidence: 84%

“…The observed reallocation is consistent with that described by a recent UK nationwide survey [ 9 ]. The effects of these rationalization strategies and the response of the cardiac surgery system are authoritatively described in a recent paper by Belluschi et al [ 10 ] about the Lombardy reorganization model. As these systems-based changes were evolving, guidelines with adequate specificity to address the complexity of decision-making for safely and effectively performing and/or deferring cardiac surgery were unavailable or, at best, under development [ 9 , 11–13 ].…”

Section: Discussionmentioning

confidence: 99%

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Cardiac surgery practice during the COVID-19 outbreak: a multicentre national survey

Rubino

Santo

Mauro³

et al. 2021

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Healthcare systems worldwide have been overburdened by the coronavirus disease 2019 (COVID-19) outbreak. Accordingly, hospitals had to implement strategies to profoundly reshape both non-COVID-19 medical care and surgical activities. Knowledge about the impact of the COVID-19 pandemic on cardiac surgery practice is pivotal. The goal of the present study was to describe the changes in cardiac surgery practices during the health emergency at the national level. METHODS A 26-question web-enabled survey including all adult cardiac surgery units in Italy was conducted to assess how their clinical practice changed during the national lockdown. Data were compared to data from the corresponding period in 2019. RESULTS All but 2 centres (94.9%) adopted specific protocols to screen patients and personnel. A significant reduction in the number of dedicated cardiac intensive care unit beds (−35.4%) and operating rooms (−29.2%), along with healthcare personnel reallocation to COVID departments (nurses −15.4%, anaesthesiologists −7.7%), was noted. Overall adult cardiac surgery volumes were dramatically reduced (1734 procedures vs 3447; P < 0.001), with a significant drop in elective procedures [580 (33.4%) vs 2420 (70.2%)]. CONCLUSIONS This national survey found major changes in cardiac surgery practice as a response to the COVID-19 pandemic. This experience should lead to the development of permanent systems-based plans to face possible future pandemics. These data may effectively help policy decision-making in prioritizing healthcare resource reallocation during the ongoing pandemic and once the healthcare emergency is over.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Cardiac surgery practice during the COVID-19 outbreak: a multicentre national survey

Rubino

Santo

Mauro³

et al. 2021

European Journal of Cardio-Thoracic Surgery

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“…This system is based on a “three-colour” stratification of patients on the waiting list ( Table 1 ), corresponding to recommended delays to surgical treatment in the pandemic context. Other experts in cardiology and cardiothoracic surgery published similar recommendations in their respective countries, with patient admission and management purposes [3] , [4] , [5] , [6] .…”

Section: Introductionmentioning

confidence: 99%

Adult cardiac surgery during COVID-19 lockdown: Impact on activity and outcomes in a high-volume centre

Nader

Anselmi

Tomasi

et al. 2021

Archives of Cardiovascular Diseases

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“…The following criteria were considered for the choice of the hubs: the presence of at least 3 simultaneously dedicated 24/7 operating rooms (ORs) and the presence of a COVID-19-free postoperative ICU. In addition, a hub should guarantee patient access/hospitalization by providing multiple available medical teams (with at least 1 team on active duty 24/7), activate a ‘fast-track’ for non-COVID emergency/urgent patients, collaborate with spoke teams in their respective hubs and ensure that patient transport was managed by the forwarding hospital [ 21 ]. Once the patient was admitted, a nasal swab was performed as soon as possible.…”

Section: Methodsmentioning

confidence: 99%

Adult cardiovascular surgery and the coronavirus disease 2019 (COVID-19) pandemic: the Italian experience

Donatelli

Miceli

Glauber

et al. 2020

Interactive CardioVascular and Thoracic Surgery

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The coronavirus disease 2019 (COVID-19) pandemic has profoundly affected all health care professionals. The outbreak required a thorough reorganization of the Italian regional local health care system to preserve resources such as ventilators, beds in intensive care units and surgical and anaesthesiological staff. Levels of priority were created, together with a rigorous triage procedure for patients with COVID-19, which led to postponement of all elective procedures. Urgent cases were discussed with the local heart team and percutaneous approaches were selected as the first treatment option to reduce hospital stay. COVID-19 and COVID-19-free pathways were created, including adequate preparation of the operating room, management of anaesthesiological procedures, transportation of patients and disinfection. It was determined that patients with chronic diseases were at increased risk of adverse outcomes. Systemic inflammation, cytokine storm and hypercoagulability associated with COVID-19 increased the risk of heart failure and cardiac death. In this regard, the early use of extracorporeal membrane oxygenation could be life-saving in patients with severe forms of acute respiratory distress syndrome or refractory heart failure. The goal of this paper was to report the Italian experience during the COVID-19 pandemic in the setting of cardiovascular surgery.

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First reorganization in Europe of a regional cardiac surgery system to deal with the coronavirus-2019 pandemic

Cited by 9 publications

References 7 publications

Cardiac surgery practice during the COVID-19 outbreak: a multicentre national survey

Cardiac surgery practice during the COVID-19 outbreak: a multicentre national survey

Adult cardiac surgery during COVID-19 lockdown: Impact on activity and outcomes in a high-volume centre

Adult cardiovascular surgery and the coronavirus disease 2019 (COVID-19) pandemic: the Italian experience

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