The COVID-19 outbreak and its impact on hospitals in Italy: the model of cardiac surgery

Abstract

How to manage COVID-19-positive patients who need cardiac surgery A modification of traditional workflow is mandatory during the COVID-19 outbreak, beginning with the assumption that asymptomatic persons may also be potential sources of SARS-CoV-2 [5]. Patients who need cardiac surgery are likely to be more susceptible to severe complications of COVID-19, as they are more likely to have pre-existing comorbidities such as pulmonary dysfunction, heart failure, kidney disease, arterial hypertension and multiple drug therapy. Moreover, cardiopulmonary bypass and the need of invasive mechanical ventilation can represent predisposing factors to lung disease. According to guidelines from the Lombardy Region [6], cardiac surgery hospitals have been organized in 'Hub Centres' for cardiovascular patients and 'Spoke Centres' that are satellites for †The last two authors contributed to this paper as co-senior authors. ‡ Members of the Italian Society for Cardiac Surgery Task Force on COVID-19 Pandemic are listed in the Acknowledgements section.

Impact of COVID‐19 on cardiac surgical training: Our experience in the United Kingdom

“…The strain on health care resources, despite efforts to increase hospital and intensive care capacity, has led to the need for rationing of medical equipment and interventions. Subsequently, countries have canceled/curtained elective surgery and have centralized cardiothoracic services in an attempt to provide a service 2‐4 …”

The impact of COVID‐19 on the provision of cardiac surgical services

“…Italy has also canceled elective surgery and has made dedicated cardiac centers, for example, the Lombardy region has had 16 of the 20 cardiac centers discontinue the activity and centralized to the remaining four centers in a “Hub and Spoke” model. With the “Hub” centers responsible to provide urgent and emergency cardiac services, with sharing of surgical teams across the 20 hospitals to facilitate shift organization, allowing teams from different centers to be on call 11 …”

Safety for all: coronavirus disease 2019 pandemic and cardiac surgery: a roadmap to ‘phase’ 2

“…The COVID-19 pandemic has led the emergency task forces of the 20 Italian regions to reallocate intensive care unit resources, to cancel elective surgical procedures and to allocate intensive care unit beds usually dedicated to cardiac, neurosurgery and some coronary care patients to the care of patients with COVID-19 [3]. Two models have been used to allocate cardiac surgical services.…”