28 research outputs found

    Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

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    RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≄60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

    Enseigner l'architecture en Île-de-France au XXe siĂšcle : une histoire croisĂ©e, n°8 (ENSA Paris-Malaquais / Paris-Val de Seine / Paris-La Villette)

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    International audience3. Éditos // 4. Histoires d'Ă©coles // 11. La primautĂ© de Paris en dĂ©bat, 1940-1969 : quelle dĂ©centralisation pour l'enseignement de l'architecture ? // 17. RĂ©vision et hĂ©gĂ©monie du systĂšme des Beaux-Arts : rĂ©former l’enseignement de l'architecture Ă  l'heure de Vichy // 22. L’enseignement d'AndrĂ© Gutton. Une dĂ©marche construite entre l'Institut d'Urbanisme de Paris et l'Ecole des Beaux-Arts (1921-1974) // 29. L'enseignement d'EugĂšne Beaudouin : entre agence et atelier officiel (1952-1968) // 35. L'atelier Lods, de la volontĂ© de rĂ©former Ă  l'ambition d'une nouvelle Ă©cole Ă  Paris (1954-1964) // 40. La genĂšse des ENSA parisiennes : entre libĂ©ralisme hĂ©ritĂ© et autoritĂ© contestĂ©e // 48. Une tentative de reconfiguration de la carte parisienne des Ă©coles au dĂ©but des annĂ©es 1990 : Marne-La-VallĂ©e et Nanterr

    Enseigner l'architecture en Île-de-France au XXe siĂšcle : une histoire croisĂ©e, n°8 (ENSA Paris-Malaquais / Paris-Val de Seine / Paris-La Villette)

    No full text
    International audience3. Éditos // 4. Histoires d'Ă©coles // 11. La primautĂ© de Paris en dĂ©bat, 1940-1969 : quelle dĂ©centralisation pour l'enseignement de l'architecture ? // 17. RĂ©vision et hĂ©gĂ©monie du systĂšme des Beaux-Arts : rĂ©former l’enseignement de l'architecture Ă  l'heure de Vichy // 22. L’enseignement d'AndrĂ© Gutton. Une dĂ©marche construite entre l'Institut d'Urbanisme de Paris et l'Ecole des Beaux-Arts (1921-1974) // 29. L'enseignement d'EugĂšne Beaudouin : entre agence et atelier officiel (1952-1968) // 35. L'atelier Lods, de la volontĂ© de rĂ©former Ă  l'ambition d'une nouvelle Ă©cole Ă  Paris (1954-1964) // 40. La genĂšse des ENSA parisiennes : entre libĂ©ralisme hĂ©ritĂ© et autoritĂ© contestĂ©e // 48. Une tentative de reconfiguration de la carte parisienne des Ă©coles au dĂ©but des annĂ©es 1990 : Marne-La-VallĂ©e et Nanterr
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