How to keep the cath-lab of a hub center "covid free" during the pandemic in a hub & spoke cardiology network: a single center experience and literature review.

Borghesi, Marco; Zilio, Filippo; Braito, Giuseppe; Dallago, Michele; Muraglia, Simone; Todaro, Daniel; Bonmassari, Roberto

BACKGROUND north of Italy has been one of the most affected area in the world by the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2). The healthcare system has been overwhelmed by the huge number of patients in need of mechanical ventilation or intensive care, resulting in a delay of treatment of patients with acute coronary syndrome (ACS), due to a crash in STEMI networks and closure of a certain number of hub centers, and to a delay in patients' seeking for medical evaluation for chest pain or angina-equivalent symptoms. METHODS in the Trentino region, a mountainous area with about 500,000 inhabitants, very close to Lombardy that was the epicenter of the pandemic in Italy, to avoid these dramatic consequences, we developed a new protocol tailored to our specificity to keep our institution, and above all the cath-lab, clean from the SARS-CoV-2 infection, to ensure full operativity for cardiologic emergencies. RESULTS Applying this protocol during the two months of the peak of the infection in Italy no one of the staff members of the cath-lab, the ICCU or the cardiology ward tested positive to nasal swab for SARS-CoV-2 and the same result was obtained for all the patients admitted to our units. CONCLUSIONS our real world experience shows that during the COVID-19 pandemic, quick activation of an appropriate protocol defining specific pathways for patients with a medical urgency is effective in minimizing healthcare personnel exposure and to preserve full operativity of the hub centers. This issue will be of a crucial importance, now that we are facing the second wave of the pandemic.