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.).