CARDIAC SURGERY
Despite the administrative and logistic difficulties to establish real cooperation between private and public hospitals, the realization of the hub-spoke network had been successful. Reorganizing human and logistic resources took a few days. Nevertheless, all the patients had always found a hospital ready to treat their urgent and emergent pathology regardless of their admittance origin. Furthermore, real cooperation between core and referral centers, difficult to believe since a couple a months ago, has permitted to evaluate and treat also patients with a not deferrable disease, avoiding the worsening of their clinical conditions. In case of not transferrable emergencies, the presence of an on-call team in the spoke center seemed to be useful as happened in five cardiac surgery cases during the analyzed period.
Preoperative COVID screening and subsequent hospital areas and pathways separation has permitted to guarantee patients’ safety. No one of the treated cases admitted as COVID-free became later infected, demonstrating substantial adequacy of our safety measure applied.
A further demonstration of efficacy and safety of the hub role is represented by the zero in-hospital mortality achieved in the first 30-days of our cardiac surgery activity. This is absolutely comparable with the high standard results of the previous years. Non-COVID patients can be treated with no adjunctive risks if all the safety protocols to separate pathways and areas are applied 11Bonalumi G, Di Mauro M, Garatti A, Barili F, Gerosa G, Parolari A; Italian Society for Cardiac Surgery Task Force on COVID-19 Pandemic. The COVID-19 outbreak and its impact on hospitals in Italy: the model of cardiac surgery. Eur J Cardiothorac Surg. 2020 Apr 17. pii: ezaa151. doi: 10.1093/ejcts/ezaa151. [Epub ahead of print] No abstract available.  PMID:32301984. In cardiac surgery, we showed an important reduction of urgent cases compared to the same period in 2019 in the same area. This impression is confirmed by the data published by others about acute coronary syndromes and cardiovascular pathologies diagnosis during the sars-cov19 pandemic 22Metzler B, Siostrzonek P, Binder RK, Bauer A, Reinstadler SJ. Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage [published online ahead of print, 2020 Apr 16]. Eur Heart J. 2020;ehaa314,33Tam CF, Cheung KS, Lam S, et al. Impact of Coronavirus Disease 2019 (COVID-19) Outbreak on ST-Segment-Elevation Myocardial Infarction Care in Hong Kong, China. Circ Cardiovasc Qual Outcomes. 2020;13(4):e006631. doi:10.1161/CIRCOUTCOMES.120.006631,44Garcia S, Albaghdadi MS, Meraj PM, et al. Reduction in ST-Segment Elevation Cardiac Catheterization Laboratory Activations in the United States during COVID-19 Pandemic [published online ahead of print, 2020 Apr 9]. J Am Coll Cardiol. 2020;S0735-1097(20)34913-5,55Rodríguez-Leor O, et al. Impacto de la pandemia de COVID-19 sobre la actividad asistencial en cardiología ntervencionista en España. REC Interv Cardiol.2020. doi:10.24875/RECIC.M20000120