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Chieregato A, Veronese G, Curto F, Zaniboni M, Fossi F, Zumbo F, Scattolini C, Compagnone C, Alberti BM, Baciu C, Bergesio L, Carenini SM, Cipolla C, Formentano AC, Guidi A, Massimo F, Galluccio I, Pagani S, Paparone R, Pozzi F, Pressato L, Pugnetti E, Riganti M, Ruggieri F, Tagliaferri F, Trinchero G, Vassena E, Bassi G, Giudici R, Sacchi M, Chiara O, Agostoni EC, Grasselli G, Fumagalli R. 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. Minerva Anestesiol 2021; 87:1091-1099. [PMID: 34102806 DOI: 10.23736/s0375-9393.21.15455-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Arturo Chieregato
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy -
| | - Giacomo Veronese
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Francesco Curto
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Matteo Zaniboni
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesca Fossi
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fabrizio Zumbo
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Carla Scattolini
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Christian Compagnone
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Beatrice M Alberti
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Camelia Baciu
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lavinia Bergesio
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano M Carenini
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Cristiana Cipolla
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Alessandro Guidi
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Massimo
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Irene Galluccio
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Silvano Pagani
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Rosaria Paparone
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federico Pozzi
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lorenzo Pressato
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Enrica Pugnetti
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Mauro Riganti
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Ruggieri
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fernanda Tagliaferri
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gabriele Trinchero
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Emanuele Vassena
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gabriele Bassi
- Department of Anesthesia and Intensive Care 1, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Riccardo Giudici
- Department of Anesthesia and Intensive Care 1, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Sacchi
- SOREU, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Local Organ Procurement Organization, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Osvaldo Chiara
- School of Medicine and Surgery, University of Milan, Milan, Italy.,Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elio C Agostoni
- Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Anesthesia and Intensive Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Fumagalli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Department of Anesthesia and Intensive Care 1, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Chevallard G, Veronese G, Giudici R, Pressato L, Pozzi F, Compagnone C, Fossi F, Bernasconi F, Curto F, Zaniboni M, Bassi G, Chiara O, Fumagalli R, Chieregato A. Facing increased suicide attempts during COVID-19 pandemic lockdown: the experience from the major trauma center in Lombardy, Italy. Minerva Anestesiol 2020; 87:243-245. [PMID: 33174409 DOI: 10.23736/s0375-9393.20.14970-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Giorgio Chevallard
- Neuroscience Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giacomo Veronese
- Neuroscience Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Health Sciences, University of Milano-Bicocca, Monza, Monza-Brianza, Italy
| | - Riccardo Giudici
- Emergency Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lorenzo Pressato
- Neuroscience Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federico Pozzi
- Neuroscience Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Christian Compagnone
- Neuroscience Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesca Fossi
- Neuroscience Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Filippo Bernasconi
- SOREU Metropolitana, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Curto
- Neuroscience Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Matteo Zaniboni
- Neuroscience Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gabriele Bassi
- Emergency Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Osvaldo Chiara
- Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,University of Milan, Milan, Italy
| | - Roberto Fumagalli
- Department of Health Sciences, University of Milano-Bicocca, Monza, Monza-Brianza, Italy.,Emergency Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Arturo Chieregato
- Neuroscience Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy -
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