Reorganization of resources
Italy was the first European country to be massively hit by the
SARS-CoV-2 infection, and for this reason it had to react quickly and
effectively to the resulting health chaos, especially in the Lombardy
region, which was the most strongly affected at first. This reaction has
been exemplary, with a change in the healthcare model introduced almost
immediately. On March 8, 2020, the Italian government announced the
closure of the affected regions and that same day, the Lombardy regional
government reviewed the entire system and introduced new regulations on
how to reorganize hospitals according to a “hub & spoke” model. Four
hub centers were created for adult cardiac surgery and one for pediatric
surgery, which would handle all emergency cases (150–200 cases/month)
and the existing ECMO network remained unchanged14.
Due to the special decentralized administrative structure of Spain, with
the health competences assigned to regional governments and the hospital
organization regulated by the management of each center, the
restructuring of cardiac surgery during the pandemic has been similar to
that of Italy, but without the radial scheme. Each hospital has operated
in a nuclear manner, with the independence to define surgical
strategies, relocate ICUs, and organize emergency services. In practice,
the action has been quite homogeneous and followed the guidelines set by
the SECCE1. All elective medical activity (ambulatory
and surgical) was canceled, some hospitals were completely transformed
into COVID-19 hospitals, exclusive routes were organized for patients
with COVID-19 within the hospital, and completely new COVID-19 intensive
care units were created in different hospital facilities (operating
theaters, postsurgical critical care areas, rehabilitation gyms, etc.).