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

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/)

Offset phase locking of noisy diode lasers aided by frequency division

International audienceFor heterodyne phase locking, frequency division of the beat note between two oscillators can improve the reliability of the phase lock and the quality of the phase synchronization. Frequency division can also reduce the size, weight, power, and cost of the instrument by excluding the microwave synthesizer from the control loop when the heterodyne offset frequency is large (5 to 10 GHz). We have experimentally tested the use of a frequency divider in an optical phase-lock loop and compared the achieved level of residual phase fluctuations between two diode lasers with that achieved without the use of a frequency divider. The two methods achieve comparable phase stability provided that sufficient loop gain is maintained after frequency division to preserve the required bandwidth. We have also numerically analyzed the noise properties and internal dynamics of phase-locked loops subjected to a high level of phase fluctuations, and our modeling confirms the expected benefits of having an in-loop frequency divider

HORACE: A compact cold atom clock for Galileo

International audienceHORACE (HOrloge à Refroidissement d'Atomes en Cellule = clock based on atoms cooled from vapour cell) is a compact cold caesium atom clock developed in SYRTE at Paris Observatory. This clock can operate both on ground and in microgravity environment. Design of HORACE is based on isotropic light cooling, allowing performing the whole clock sequence (cooling, atomic preparation, Ramsey interrogation and detection) at the same place. Compared to more conventional cold atom clocks such as atomic fountains, the use of isotropic light cooling simplifies both the optical part of the setup and the detection sequence, and leads to a drastic size reduction of the physics package. Very good short-term performances have been demonstrated at SYRTE since relative frequency instability of 2.2 × 10-13 tau-1/2 has been obtained. Optimization of the long term stability is still under progress and current results show relative frequency instability around 3 × 10-15 in 104 s of integration. With these performances, HORACE appears as a good candidate both for Galileo's ground segment clock and for onboard Galileo clock

High-stability compact atomic clock based on isotropic laser cooling

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Fonctionnement d'une horloge compacte à atomes froids

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A new design of ECLD for compact atomic clocks

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Estimation of the compact cold atom clock HORACE frequency stability

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Reaching a Few 10−13^{-13} {τ\tau}−1/2^{-1/2} Stability Level with a Compact Cold Atom Clock

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Reaching a few 10−13τ−1/210^{-13}\tau^{-1/2} stability level with the compact cold atom clock HORACE

International audienc

Estimation of the compact cold atom clock HORACE frequency stability

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