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/)

La Fête est finie / Delanoë (P.), Schachtel (J.). Un Amour comme notre amour / Capez (M.), Stern (E.). Les Printemps d'aujourd'hui / Marnay (E.), Magenta (G.). La Complainte de Paris / Marnay (E.), Stern (E.) ; Lebas (Renée), avec Russell (Art) et son orchestre

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Giovinella / E. Marnay ; L. Poll. Les Fleurs et l'amour / F. Lemarque ; D. Modugno ; René Lebas ; Acc. par Wal-Berg et son Orchestre ; Groupe Vocal : les Blues Stars

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LA VALSE A MILLE TEMPS / BREL (J). COMPLAINTE DE PARIS / MARNAY (E) et STERN (E). QUAND TU VAS REVENIR / AZNAVOUR (Ch). TE GENES PAS / VAREL et BAILLY ; LEBAS (Renée) (chant) ; avec FONTANA (Mario) et son orchestre

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Assessing physicians’ and nurses’ experience of dying and death in the ICU: development of the CAESAR-P and the CAESAR-N instruments

International audienc

CAESAR: a new tool to assess relatives' experience of dying and death in the ICU

International audienc

Complicated grief after death of a relative in the intensive care unit

International audienc

Mental health and stress among ICU healthcare professionals in France according to intensity of the COVID-19 epidemic

International audienceBackground We investigated the impact of the COVID-19 crisis on mental health of professionals working in the intensive care unit (ICU) according to the intensity of the epidemic in France. Methods This cross-sectional survey was conducted in 77 French hospitals from April 22 to May 13 2020. All ICU frontline healthcare workers were eligible. The primary endpoint was the mental health, assessed using the 12-item General Health Questionnaire. Sources of stress during the crisis were assessed using the Perceived Stressors in Intensive Care Units (PS-ICU) scale. Epidemic intensity was defined as high or low for each region based on publicly available data from Santé Publique France. Effects were assessed using linear mixed models, moderation and mediation analyses. Results In total, 2643 health professionals participated; 64.36% in high-intensity zones. Professionals in areas with greater epidemic intensity were at higher risk of mental health issues ( p < 0.001), and higher levels of overall perceived stress ( p < 0.001), compared to low-intensity zones. Factors associated with higher overall perceived stress were female sex ( B = 0.13; 95% confidence interval [CI] = 0.08–0.17), having a relative at risk of COVID-19 ( B = 0.14; 95%-CI = 0.09–0.18) and working in high-intensity zones ( B = 0.11; 95%-CI = 0.02–0.20). Perceived stress mediated the impact of the crisis context on mental health ( B = 0.23, 95%-CI = 0.05, 0.41) and the impact of stress on mental health was moderated by positive thinking, b = − 0.32, 95% CI = − 0.54, − 0.11. Conclusion COVID-19 negatively impacted the mental health of ICU professionals. Professionals working in zones where the epidemic was of high intensity were significantly more affected, with higher levels of perceived stress. This study is supported by a grant from the French Ministry of Health (PHRC-COVID 2020)