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Planning for the assistance of critically ill patients in a Pandemic Situation: The experience of Vall d’Hebron University Hospital
Organización de la atención a pacientes críticos en situación de pandemia: Experiencia del Hospital Vall d’Hebron durante el brote de neumonía por SARS-CoV-2
Ricard Ferrera,
Corresponding author
r.ferrer@vhebron.net

Corresponding author.
, Marcelino Báguenab, Joan Balcellsc, Jordi Bañerasd, Alfons Biarnese, Miriam de Nadale, Rosa María Graciaa, Jesús Martinezf, Xavier Nuvialsa, Jordi Rieraa, Oriol Rocaa, Juan Carlos Ruiz-Rodrigueza
a Servicio de Medicina Intensiva, Hospital Universitario Vall d’Hebron, Sepsis Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d’Hebron Institut de Recerca (VHIR), Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
b Servicio de Medicina Intensiva, Hospital Universitario de Traumatología, Rehabilitación y Quemados Vall d’Hebron, Barcelona, Spain
c Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Vall d’Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
d Acute Cardiovascular Care Unit, Department of Cardiology, Centre de Simulació Clínica Avançada VHISCA, Vall d’Hebron Hospital, Universidad Autónoma de Barcelona, CIBERCV, Barcelona, Spain
e Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d’Hebron, Barcelona, Spain
f Coordinador de Críticos, Hospital Universitario Vall d’Hebron, Barcelona, Spain
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        "titulo" => "Organizaci&#243;n de la atenci&#243;n a pacientes cr&#237;ticos en situaci&#243;n de pandemia&#58; Experiencia del Hospital Vall d&#8217;Hebron durante el brote de neumon&#237;a por SARS-CoV-2"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Graph showing COVID-19 cases admitted to the intensive care unit&#46; ICU&#58; intensive care unit&#59; HFNC&#58; high-flow nasal cannulae&#59; ECMO&#58; extracorporeal membrane oxygenation&#59; IMV&#58; invasive mechanical ventilation&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">On 11th March 2020&#44; Tedros Adhanom Ghebreyesus&#44; WHO Director-General&#44; declared the coronavirus outbreak &#40;COVID-19&#41; a pandemic&#46; The first recorded COVID-19 case in Spain was diagnosed on 31st January 2020&#46; It was a mild and imported case involving a German patient who was admitted to hospital in La Gomera&#44; Canary Islands&#46; The first cases on the Iberian peninsula were reported on 24th February&#46; After this&#44; the virus spread exponentially across the different provinces and lockdown was imposed on the population on 13th March&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Inspired by the slogan &#8220;Hope for the best&#44; prepare for the worst&#8221;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#44; and based on the Contingency Plan of the Spanish Society of Intensive Care and Critical Care Medicine and Coronary Units &#40;Sociedad Espa&#241;ola de Medicina Intensiva&#44; Cr&#237;tica y Unidades Coronarias&#44; SEMICYUC&#41;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#44; Hospital Universitario Vall d&#8217;Hebron &#40;HUVH&#41; has developed an unprecedented healthcare device for critically ill patients&#46; The mortality of the outbreak would depend more on the healthcare system&#8217;s ability to respond than on the treatments administered<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; This manuscript describes the organisation&#44; challenges and outcome of the expansion of critical area capacity and resources in response to the pandemic&#44; which may be a key factor in similar future scenarios&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methodology</span><p id="par0015" class="elsevierStylePara elsevierViewall">This manuscript describes the predictions made&#44; the measures taken and the main outcomes in a cohort of critically ill patients during the first two months &#40;3rd March to 2nd May 2020&#41; of the COVID-19 pandemic at HUVH in Barcelona&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Pandemic predictions for the HUVH healthcare area</span><p id="par0020" class="elsevierStylePara elsevierViewall">HUVH started to prepare the transformation strategy on 31st January&#44; three weeks before the first non-imported case was diagnosed in Spain&#46; The epidemic in China was monitored using WHO data<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> from 22nd January 2020 and various predictive scenarios were analysed to adjust available hospital resources to the number of COVID-19 cases diagnosed at our hospital&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">HUVH is the community hospital of the Barcelona Nord area&#44; which comprises five districts with a population of more than 439&#44;654 people<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; It is a tertiary referral hospital for the whole Autonomous Community of Catalonia for multiple specialties and pathologies&#44; including with extracorporeal membrane oxygenation &#40;ECMO&#41; support therapy and obstetrics&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Predictions made</span><p id="par0030" class="elsevierStylePara elsevierViewall">The cumulative cases &#40;cumulative incidence&#41; in the Barcelona Nord area were predicted&#46; Three incidence rates were taken into consideration&#58; the mean rate in China &#40;5&#46;7 cases&#47;100&#44;000 inhabitants or 0&#46;0057&#37;&#41;&#59; the average rate of the provinces with the lowest incidence rate &#40;all&#44; except Hubei&#41;&#44; with 1 case&#47;100&#44;000 inhabitants &#40;0&#46;001&#37;&#41;&#59; and the Hubei rate on 11th March 2020&#44; with 114&#46;5 cases&#47;100&#44;000 inhabitants &#40;0&#46;1145&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; Based on a report by WHO and the Italian Ministry of Health on the incidence rate in Lombardy<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#44; a fourth rate of 150 cases&#47;100&#44;000 inhabitants was considered&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The same proportion of serious cases was taken into account&#44; according to WHO data &#40;18&#37;&#41;&#44; and 10&#37; of these were considered to require ICU admission&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the predicted serious cases and cases requiring ICU admission for the population of the Nord Integral Healthcare Area &#40;&#193;rea Integral de Salud&#44; AIS&#41; with these four incidence rates&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The Epidemiology Department of our hospital estimated the impact of an epidemic wave of SARS-CoV-2 infections on the HUVH referral region&#44; with an attack rate &#40;cumulative incidence&#41; of 2&#46;5&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; This prediction also estimates the epidemic outbreak in eight weeks time and distributes cases according to a possible epidemic curve&#44; which allows a better estimate of necessary resources &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Critical care unit expansion plan</span><p id="par0045" class="elsevierStylePara elsevierViewall">To optimise resources&#44; a plan was drafted in advance to progressively increase the hospital&#8217;s critical care bed capacity using the following criteria&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1</span><p id="par0050" class="elsevierStylePara elsevierViewall">Prioritisation according to ease of implementation&#44; resource needs and impact on the organisation &#40;e&#46;g&#46;&#44; involvement of the surgical programme&#44; transplant programme&#44; etc&#46;&#41;&#59;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2</span><p id="par0055" class="elsevierStylePara elsevierViewall">Incorporation of existing repurposed devices&#59;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3</span><p id="par0060" class="elsevierStylePara elsevierViewall">Incorporation of new devices that need to be adapted&#46; Bright isolated spaces fitted with temporary medicinal gas supplies and the corresponding electrical fittings were created&#46;</p></li></ul></p><p id="par0065" class="elsevierStylePara elsevierViewall">It was possible to expand the critical care facilities to 268 ICU beds &#40;initial provision 123 beds&#59; repurposed units 52 beds&#59; and new units 97 beds&#41;&#46; Four paediatric beds were used for adults &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; These beds were allotted as follows&#58; 205 beds for COVID-19 patients&#44; 26 beds for other diseases and 37 for Paediatrics and Neonatal Care&#46; The beds were sent to 13 units distributed throughout three buildings&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">A Respiratory Intermediate Care Unit&#44; run by the Pneumology Department&#44; was created to allow early discharge from the Critical Care Units&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">This expansion forced us to reduce scheduled surgical activities and organ donation and transplantation programme activities&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Adaptation of human resources</span><p id="par0080" class="elsevierStylePara elsevierViewall">The Intensive Care Medicine Department&#8217;s regular <span class="elsevierStyleItalic">staff</span> is not adequate to take on all the activity generated as a result of the resource expansion plan&#46; Up to 40&#37; of the professionals are unlikely be unable to work at different times as a result of contracting the disease &#40;at work or in the community&#41; and work routines would need to be organised to take into consideration breaks&#46; Three-day shifts have been organised with 24&#8239;h on duty and 48&#8239;h off&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">It has been necessary to reincorporate all intensive care medicine doctors working outside the ICU &#40;teaching&#44; transplant coordination&#41; and also recently retired professionals&#46; Multidisciplinary teams of professionals from critical areas &#40;Anaesthesia and Resuscitation&#44; cardiologists and paediatricians from the paediatric ICU and neonatal ICU&#41; have been created&#44; supervised and coordinated by the ICU&#46; In total&#44; 250 professionals are coordinated online&#46; The teams are complemented by medical professionals with little or no ICU training who are assigned tasks such as clinical documentation&#44; safety protocols&#44; information for family members and consent requests&#46; High-risk professionals &#40;elderly and approaching retirement&#44; retired&#44; pregnant&#44; clinically significant chronic respiratory diseases and immunocompromised professionals&#41; have been given the role of managing patients with other diseases&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">To guarantee the psychological and mental health of professionals&#44; specific support programmes have been set up by the HUVH Psychiatry and Psychology Departments&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Coordination&#44; communication and training coordination</span><span id="sec0031" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0091">Coordination</span><p id="par0095" class="elsevierStylePara elsevierViewall">An operating committee &#40;heads of the Intensive Care Medicine and Anaesthesiology departments&#44; HUVH Critical Care coordinator and the coordinators of the various units&#41; was created&#46; Every morning these individuals report the number of admissions&#47;discharges per unit from the previous day and the expected number of discharges&#46; A healthcare coordinator is also responsible for sending professionals each day to the areas experiencing the highest work overload on a day-by-day basis&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Communication</span><p id="par0100" class="elsevierStylePara elsevierViewall">Internal communication is possible on two levels using online tools&#46; The operating committee meets every day between 2&#46;00 p&#46;m&#46; and 3&#46;00 p&#46;m&#46; using Zoom &#40;Zoom Video Communications Inc&#46;&#44; San Jos&#233;&#44; California&#41;&#46; These meetings allow the committee to discuss healthcare coordination&#44; changes in protocols&#44; difficult clinical decisions&#44; patient rounds and troubleshooting&#46; Communication with other professionals who are members of the ICU-COVID team is possible by instant messaging &#40;WhatsApp Inc&#46;&#44; Mountain View&#44; California&#41;&#44; thereby ensuring homogeneous healthcare and the daily updating of the progress of inpatients&#46; An on-call intensive care medicine doctor is also available 24&#8239;h a day for consultation purposes&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Training</span><p id="par0105" class="elsevierStylePara elsevierViewall">Training was provided on personal protective equipment &#40;PPE&#41;&#44; including simulations to ensure correct use&#44; donning and removal of PPE&#44; proning and the different ventilators&#46; A webinar has been given on a weekly basis on updates for treating critically ill patients with COVID-19 pneumonia&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Equipment</span><p id="par0110" class="elsevierStylePara elsevierViewall">The equipment required most frequently has been mechanical ventilators&#46; With the expansion of the different critical care areas&#44; different types of ventilators have been used&#58; ICU ventilators&#44; anaesthetic machines &#40;AM&#41;&#44; repurposed non-invasive ventilation &#40;NIV&#41; ventilators and transport ventilators&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">AMs have been modified to an open system&#46; To do this&#44; it was necessary to&#58; &#40;1&#41; adjust the fresh gas flow to a minimum of 1&#46;5 times the minute volume delivered to the patient&#59; &#40;2&#41; <span class="elsevierStyleItalic">bypass</span> the soda lime on those AMs that permitted this &#40;inspired and expired CO2 was monitored to rule out the presence of rebreathing&#41;&#59; and &#40;3&#41; humidify the inspired air to prevent endotracheal tube occlusion&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Each new ICU bed had a bedside monitor with centralised alarms on a central monitor and four infusion pumps&#46; Each new unit was equipped with a gas analyser&#46; The number of extrarenal clearance monitors has been increased from 18 to 25&#46; However&#44; only 5&#46;6&#37; of critically ill patients have required extrarenal clearance techniques and therefore this increase in devices has not been required&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Extracorporeal membrane oxygenation &#40;ECMO&#41; equipment</span><p id="par0125" class="elsevierStylePara elsevierViewall">The Department of Health &#40;Departament de Salut&#41; identified HUVH as an ECMO Centre&#44; a referral hospital for ECMO-based respiratory care for COVID-19 patients&#46; Calculations were therefore done to determine the number of referrals we would receive&#46; Using the FluSurge platform&#44; it was determined that 5&#8211;8 patients admitted to the HUVH ICU would need ECMO therapy during the pandemic&#46; It was also calculated that we would receive 55 referrals from other sites during the pandemic with eight referrals&#47;week at the peak of the pandemic&#46; After considering this data&#44; the amount of material required was adjusted as shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46; Criteria for the indication and contraindication of ECMO in COVID-19 patients were adjusted after taking into consideration prior experience during the H1N1 pandemic&#44; the little known about the pathophysiology of the disease and the potential lack of resources&#46; Posters outlining these criteria and the HUVH <span class="elsevierStyleItalic">team&#8217;s</span> ECMO referral variables were sent to all the country&#8217;s ICUs &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Adaptation of protocols and drugs</span><p id="par0130" class="elsevierStylePara elsevierViewall">It is not possible to give specific therapeutic recommendations for coronavirus &#40;SARS-CoV-2&#41;&#46; Recommendations have been based on knowledge gained during other viral pandemics &#40;e&#46;g&#46;&#44; flu&#44; severe acute respiratory syndrome due to other coronaviruses &#91;SARS&#93;&#44; Middle East respiratory syndrome &#91;MERS&#93;&#41;&#44; on improved evidence on the respiratory management of patients with acute respiratory distress syndrome &#40;ARDS&#41; and on recent relevant publications on COVID-19&#46; It is vitally important that recommendations are coordinated and designed in accordance with each hospital&#8217;s capabilities and the patient&#39;s individual characteristics&#46; The resulting document has been periodically updated according to new relevant evidence&#44; incorporating all local experiences&#46; It includes criteria for admission&#44; invasive mechanical ventilation &#40;IMV&#41;&#44; antiviral and immunomodulatory therapy &#40;drugs and extracorporeal options&#41;&#44; anticoagulation&#44; kidney and heart disease control&#44; airway management &#40;intubation&#44; tracheotomy&#41; and ECMO in refractory cases&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Consumables</span><p id="par0135" class="elsevierStylePara elsevierViewall">A contingency plan was drafted with recommendations for the rational use of PPE based on the prioritisation of care and difficulties restocking material due to <span class="elsevierStyleItalic">supply</span> shortages<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46; A mask can be reused provided that it is intact &#40;unsoiled and undamaged&#41; and not wet&#46; The nursing supervisor of each unit is responsible for high-filtration masks&#58; FPP3 mask &#40;for intubation&#44; tracheotomy&#44; fibrobronchoscopy&#41; and&#47;or FPP2 mask&#46; These are reused for the entire shift&#44; protected by a surgical mask&#46; They are then resterilised at the end of each shift with hydrogen peroxide&#46; Safety goggles are reused after washing with enzymatic cleaner&#46; Fluid-resistant gowns are reused and resterilised with hydrogen peroxide&#44; provided that their structure is intact and there are no secretions or macroscopic fluids&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The use of disposable fibrobronchoscopes &#40;Amb&#250;&#169; aScope 4 Broncho Regular&#41; has been prioritised and reuse in the same patient throughout his&#47;her ICU admission is preferable&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Treatment of special populations during the pandemic&#58; children and pregnant women</span><p id="par0145" class="elsevierStylePara elsevierViewall">This is based on the following premises&#58; 1&#46; Need to maintain the ability to provide care for critically ill children but setting aside a few beds for adult patients&#59; 2&#46; Need to collaborate with the care system for critically ill adult patients infected with COVID-19 from the HUVH campus&#59; 3&#46; Need to provide top-quality care to pregnant women infected with COVID-19&#44; as a referral hospital for these patients&#44; by organising care for critically ill obstetric patients with COVID-19 or other obstetric disorders&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Method&#58; 1&#46; Four semi-critical care beds have been added in the area adjacent to the Paediatric Intensive Care Unit &#40;PICU&#41;&#44; which is usually used as a post-anaesthesia recovery area&#44; and all non-urgent surgical procedures have been cancelled&#44; with the exception of the paediatric solid organ transplantation programmes&#59; 2&#46; Pregnant women requiring admission to the ICU have been admitted to the PICU&#46; The advantage of this option is its proximity to the Obstetrics team&#44; Neonatology team and delivery room&#44; which are all located on the same floor just a few metres from the Unit&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Plan for communication with family members and bioethics</span><p id="par0155" class="elsevierStylePara elsevierViewall">At this stage&#44; we have had to work with patients who have been forcibly isolated from their family unit&#44; families who are in crisis situations far away from their loved ones and individuals who are potentially in a situation where they will get sick &#40;or are already sick&#41;&#46; These situations have required that we communicate via electronic systems &#40;mainly the phone and video calls&#41;&#46; We have created infographics&#44; made available on the hospital&#8217;s website&#44; as an aid for families to help them understand even the most complicated medical information&#46; End-of-life visits have been kept as short as possible and limited to one relative&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Decisions regarding admissions and ceiling of care have been made based on the recommendations of the SEMICYUC<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and specific recommendations of the hospital&#39;s Bioethics Committee at the request of the Intensive Care Medicine Department&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Change in ICU admissions and overall results</span><p id="par0165" class="elsevierStylePara elsevierViewall">Between 3rd March and 2nd May 2020&#44; 333 patients were admitted to the Critical Care Units at HUVH &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The number of new cases peaked on 25th March with 24 cases a day&#44; while the number of admissions peaked on 6th April with 170 cases in the different ICUs&#46; In addition&#44; the number of cases requiring ECMO support peaked on 18th April with 9 concomitant cases&#46; During these two months&#44; the percentage of patients on IMV or IMV and ECMO remained at all times above 78&#37;&#46; Sixty days after the first patient with COVID-19 pneumonia was admitted to the ICU&#44; 55 patients were still hospitalised&#46; Most patients have been men &#40;65&#37;&#41; and the most common age group has been 60&#8211;70 years&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">During the study period&#44; 23 patients received ECMO support and 18 of these patients were cannulated at another hospital and transferred to HUVH&#46; On the study closeout date&#44; 14 patients had had their cannulas removed satisfactorily&#44; 3 patients had died and all other patients remained on ECMO support&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">During the study period&#44; eight pregnant women were admitted to the ICU&#44; including one woman expecting twins with pneumonia&#46; Three pregnant women required high-flow oxygen therapy and five required IMV&#46; Four patients required caesarian sections resulting in five healthy babies&#46; All other pregnant women are continuing with their pregnancy&#46; The survival rate of this population has therefore been 100&#37;&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">ICU mortality rates for the different age groups &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41; show increasing mortality with age and the ICU mortality rate for patients younger than 60 years of age was 3&#46;2&#37;&#46; The mean time in the ICU of all patients who were discharged or died has been 14 days&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Discussion</span><p id="par0185" class="elsevierStylePara elsevierViewall">The care of patients who were critically ill with COVID-19 pneumonia during the pandemic has been the greatest challenge faced by Intensive Care Medicine departments throughout history<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">By 2nd May 2020&#44; a total of 217&#44;466 cases had been confirmed in Spain&#46; Of these&#44; 118&#44;495 patients required hospitalisation&#44; 10&#44;974 required admission to the ICU and 25&#44;264 died due to complications associated with COVID-19 infection<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; In Catalonia&#44; 50&#44;234 cases have been confirmed&#44; making this the second most affected province&#44; with 2844 cases requiring admission to the ICU&#46; As described in this manuscript&#44; HUVH has taken care of 333 critically ill patients &#40;11&#46;7 and 3&#46;0&#37; of the total number of critically ill patients in Catalonia and Spain&#44; respectively&#41;&#46; In this manuscript we have described the practical application of Contingency Plans at one of the Spanish hospitals that has seen most patients critically ill with COVID-19 pneumonia&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">The clinical outcomes observed at HUVH have been better than those described previously in the literature<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a>&#46; These better outcomes cannot be explained by differences in the therapies administered&#44; due to the lack of any one treatment with proven efficacy&#44; but rather by the organisation&#8217;s ability to adapt to the pandemic&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Key organisational changes made at HUVH include&#58; &#40;1&#41; Reduction in surgeries and activities of the organ donation and transplantation programme&#59; &#40;2&#41; early increase in critical care beds&#59; &#40;3&#41; training of multidisciplinary teams led by intensive care medicine specialists with suitable work and break times&#59; &#40;4&#41; mobilisation of essential equipment&#44; with any necessary modifications&#44; especially ventilators and ECMO pumps&#44; and consumables&#59; &#40;5&#41; coordination and training of teams using electronic tools&#59; &#40;6&#41; unified criteria for ICU admission&#44; IMV and ECMO&#59; &#40;7&#41; rational use of PPE and adaptation of sedation protocols to available drug <span class="elsevierStyleItalic">supplies</span>&#59; and &#40;8&#41; care of critically ill pregnant women in the PICU&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">The data observed has been much better than predicted&#44; which proves that infections due to this outbreak are hard to predict by basing forecasts on other geographical areas&#46; The heterogeneity of the disease in different countries requires close monitoring of the local epidemiology and early decision-making&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Likewise&#44; in the event of future COVID-19 outbreaks&#44; the increase in beds and the need for equipment and professionals should not interfere with the hospital&#39;s everyday activities and it is therefore appropriate to keep the increase in care facilities for the time being and adapt the intensive care medicine wards&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conclusions</span><p id="par0215" class="elsevierStylePara elsevierViewall">Practical application of the contingency plans for the care of critically ill patients with COVID-19 pneumonia is an organisational and healthcare challenge&#46; Despite the very high demand experienced over a short period of time&#44; the early planning of necessary resources at HUVH has allowed us to respond in an adequate manner with good overall results&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflicts of interest</span><p id="par0220" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "titulo" => "Critical care unit expansion plan"
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          "titulo" => "Adaptation of human resources"
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          "titulo" => "Coordination&#44; communication and training coordination"
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          "titulo" => "Equipment"
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    "fechaRecibido" => "2020-05-22"
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            0 => "COVID-19"
            1 => "Coronavirus"
            2 => "Hospital resources"
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            0 => "COVID-19"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">In the context of community transmission of the virus&#44; the impact of the pandemic on health-care systems&#44; mainly on intensive care units &#40;ICU&#41;&#44; was expected to be devastating&#46; Vall d&#8217;Hebron University Hospital &#40;HUVH&#41; implemented an unprecedented critical patient-care planning and management of resources&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">We describe a cohort of critically ill patients during the first two months of the pandemic &#40;from March 3&#44; 2020&#44; to May 2&#44; 2020&#41; in HUVH&#44; Barcelona&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">In this manuscript&#44; we report our previsions&#44; strategies implemented&#44; and the outcomes obtained&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Three-thousand and thirty-three patients were admitted to the HUVH Critical Care Units&#46; Throughout the study period&#44; the proportion of patients on IMV or IMV and ECMO remained above 78&#37;&#46; Most patients were men &#40;65&#37;&#41;&#59; the most common age group was 60&#8211;70 years&#46; Twenty-three patients received ECMO&#44; and eighteen were cannulated at another center and transferred to HUVH&#46; At the end of the study&#44; fourteen patients were successfully decannulated&#44; three patients died&#44; and the rest of the patients were still on ECMO&#46; Eight pregnant women have been treated in the ICU&#44; with a survival rate of 100&#37;&#46; The ICU mortality of patients younger than 60 years was 3&#46;2&#37;&#46; The mean ICU stay of both survivors and nonsurvivors was 14 days&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The adequate preparation for resource expansion for critically ill patients care&#44; main challenges&#44; and overall positive results can serve as a precedent for similar future scenarios&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">En un escenario de circulaci&#243;n comunitaria del virus el impacto de la pandemia sobre el sistema sanitario y en las unidades de cuidados intensivos &#40;UCI&#41; se preve&#237;a devastador&#46; El Hospital Universitario Vall d&#8217;Hebron &#40;HUVH&#41; ha desplegado un dispositivo de atenci&#243;n a pacientes cr&#237;ticos sin precedentes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Se describen las previsiones realizadas&#44; las medidas tomadas y los principales resultados en una cohorte de pacientes cr&#237;ticos durante los primeros dos meses &#40;3 de marzo al 2 de mayo del 2020&#41; de la pandemia por COVID-19 en el HUVH de Barcelona&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">En el periodo de estudio&#44; ingresaron en las Unidades de Cr&#237;ticos del HUVH 333 pacientes&#46; El porcentaje de los pacientes en VMI o VMI y ECMO se mantuvo constantemente por encima del 78&#37;&#46; La mayor&#237;a de pacientes han sido hombres &#40;65&#37;&#41;&#59; el grupo de edad m&#225;s frecuente entre 60 y 70 a&#241;os&#46; Veintitr&#233;s pacientes recibieron ECMO&#44; 18 de los cuales fueron canulados en otro centro y trasladados al HUVH&#46; A fecha de cierre del estudio&#44; 14 pacientes se decanularon satisfactoriamente&#44; 3 pacientes fallecieron y el resto siguen en soporte con ECMO&#46; Han sido atendidas en UCI 8 gestantes&#44; con una supervivencia del 100&#37;&#46; La mortalidad en UCI de los pacientes menores de 60 a&#241;os fue el 3&#44;2&#37;&#46; La estancia media en UCI de las altas y los fallecimientos ha sido de 14 d&#237;as&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Las estrategias de organizaci&#243;n de la expansi&#243;n de recursos para la atenci&#243;n de pacientes cr&#237;ticos&#44; sus principales retos y los resultados obtenidos&#44; pueden servir de clave para futuros escenarios similares&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Ferrer R&#44; B&#225;guena M&#44; Balcells J&#44; Ba&#241;eras J&#44; Biarnes A&#44; de Nadal M&#44; et al&#46; Organizaci&#243;n de la atenci&#243;n a pacientes cr&#237;ticos en situaci&#243;n de pandemia&#58; Experiencia del Hospital Vall d&#8217;Hebron durante el brote de neumon&#237;a por SARS-CoV-2&#46; Enferm Infecc Microbiol Clin&#46; 2022&#59;40&#58;71&#8211;77&#46;</p>"
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                  \t\t\t\t">504&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lombardy<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">150<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">659&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">119&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2822504.png"
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            0 => array:3 [
              "identificador" => "tblfn0005"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Data at 11&#47;03&#47;2020&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "&#42;&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Data at 16&#47;03&#47;2020&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Predictions made for the HUVH referral region &#40;Nord Integral Healthcare Area &#91;AIS&#93;&#8239;&#61;&#8239;439&#44;654 inhabitants&#41; based on data from China and Lombardy &#40;source of data&#44; WHO&#41;&#46;</p>"
        ]
      ]
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Impact of the epidemic&#47;week No&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weekly hospital admissions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">126&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">210&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">315&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">399&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">399&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">315&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">210&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">126&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cumulative weekly admissions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">126&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">336&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">651&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;050&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;449&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;764&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;974&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patients hospitalised with COVID-19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">126&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">267&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">410&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">542&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">587&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">571&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">453&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">313&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patients admitted to the ICU with COVID-19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Death of patients with COVID-19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Attack rate of 2&#46;5&#37; &#40;2&#44;500 cases&#47;100&#44;000&#41; over eight weeks&#46; Estimated weekly admissions during the epidemic period&#46;</p>"
        ]
      ]
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type of critical care unit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Existing beds&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Repurposed beds&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">New unit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">COVID&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">205&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">205&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Non-COVID&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neonatal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paediatric&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">119<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">268&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2822501.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">The four beds that are missing to make up the initial 123 beds are paediatric beds that have been repurposed for adults&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Expansion of the ICU per contingency plan&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0035"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Usual conditions</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Expansion for pandemic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Heart-lung support systems&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Three Cardiohelp&#169; &#40;Getinge&#41;&#46; ICU&#46;- One Cardiohelp&#169;&#46; ICU &#8211; Paediatric ICU&#46;- One Centrimag&#169; &#40;Abbot&#41;&#46; Operating theatre&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- One Cardiohelp&#169; provided by Getinge&#46;- Two Novalung&#169; &#40;Xenios-Fresenius&#41; purchased by HUVH&#46;- Two Centrimag&#169; provided by Abbot&#46;- One Cardiohelp&#169; provided by ICU of H&#46; Teknon&#44; Barcelona&#46;- One Novalung&#169; provided by ICU of H&#46; Sant Pau&#44; Barcelona&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Other devices</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- ECMO consumables&#58; 10 sets of Cardiohelp&#169; cannulae&#58; usual <span class="elsevierStyleItalic">stock</span> of five of each format&#44; HLS&#169; Getinge &#38; Biomedicus&#169; Medtronic&#46;- Percutaneous insertion <span class="elsevierStyleItalic">kits</span>&#58; usual <span class="elsevierStyleItalic">stock</span> of 15 sets &#40;Getinge&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Ongoing purchase of Cardiohelp&#169; and Novalung&#169; sets according to demand&#46;- Urgent purchase of 25 Fr&#47;38&#8239;cm and 19 Fr&#47;55&#8239;cm cannulae&#46; Purchase of other sizes according to demand&#46;- Ongoing purchase of percutaneous insertion <span class="elsevierStyleItalic">kits</span> &#40;Getinge&#41; according to demand&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Three Medtronic INVOS&#169; NIRS monitors&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Two Masimo O3&#169; monitors provided by Masimo&#46;- Two INVOS&#169; monitors provided by Medtronic&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Four Hemochron&#169; ACT monitors &#40;Werfen&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Two Hemochron&#169; monitors provided by PICU&#46;- Two Hemochron&#169; monitors provided by Werfen&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Staff with full ECMO training&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-Doctors&#58; 22&#46;-Nurses&#58; 81&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Three more paediatricians were employed&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#8239;&#43;&#8239;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2822503.png"
              ]
            ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Summary of material and staff adjustments made for the HUVH ECMO programme&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:12 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "COVID-19 pandemic&#58; the greatest challenge in the history of critical care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46; Ferrer"
                          ]
                        ]
                      ]
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ISSN: 2529993X
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos