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/)

Projet d'annexion d'un petit gymnase à chaque école primaire communale de garçons dans les grandes villes

Fleury Jules-Augustin. Projet d'annexion d'un petit gymnase à chaque école primaire communale de garçons dans les grandes villes. In: Bulletin administratif de l'instruction publique. Tome 5 n°95, 1866. pp. 240-241

Projet d'annexion d'un petit gymnase à chaque école primaire communale de garçons dans les grandes villes

Fleury Jules-Augustin. Projet d'annexion d'un petit gymnase à chaque école primaire communale de garçons dans les grandes villes. In: Bulletin administratif de l'instruction publique. Tome 5 n°95, 1866. pp. 240-241

L' histoire du Moyen âge racontée aux enfants

par M. Lamé Fleury, auteur de l'histoire ancienne, de l'histoire grecque, de l'histoire romaine, et de plusieurs autres ouvrages d'éducatio

Apport des données radar SAR à la surveillance d'éruptions volcaniques en phase paroxysmique. Application à deux volcans : Soufrière Hills de Montserrat (Antilles) et Niragongo (Zaïre)

Ce rapport présente les résultats d'une étude concernant l'utilisation de l'observation spatiale radar pour la surveillance de volcans en éruption violente interdisant d'autres techniques d'observation ou d'auscultation

Discussion of: PASKOFF, R., 2004. Potential Implications of Sea-Level Rise for France. Journal of Coastal Research, 20(2), 424–434.

International audienc

Historia de Inglaterra comprendiendo la de Escocia, Irlanda y las posesiones inglesas, con una estadística de estos diferentes paises

Las h. de grab. representan escenas de la histori