Resuscitation plus · 2026
Prehospital extracorporeal cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: a protocol for the Rapid prehospital ACcess to ECPR in Prague (RACE Prague) single-arm pilot feasibility study.
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Rob Daniel, Trhlíková Silvie, Pudil Jan, Kaválková Petra, Sviteková Klaudia, Mocková Eliška, Dusík Milan, Macoun Jaromír, Frýbová Tereza, Fichtl Jaromír, Mlejnský František, Špičák Jan, Bělohlávek Jan
Аннотация
AIM: The benefit of extracorporeal cardiopulmonary resuscitation (ECPR) in refractory out-of-hospital cardiac arrest (OHCA) is strongly time dependent, yet in established in-hospital ECPR systems, including Prague, the median collapse-to-flow time has remained around 60 min or more, dominated by intra-arrest transport. Evidence for prehospital ECPR remains limited, particularly its comparison with in-hospital ECPR. RACE Prague evaluates whether dispatching a mobile cannulation team to the scene shortens this interval within the same ECPR system.
METHODS: Single-centre, prospective, interventional, single-arm pilot feasibility study. Twenty adults aged 18-70 years with witnessed refractory OHCA (three unsuccessful defibrillations and/or ≥10 min of resuscitation in pulseless electrical activity), receive prehospital percutaneous femoro-femoral veno-arterial extracorporeal membrane oxygenation (ECMO) from a mobile ECPR team. The primary endpoint (time from estimated collapse to ECMO flow ≥2.0 L/min) is tested hierarchically against the historical Prague OHCA in-hospital ECPR cohort (target shortening ≥15 min) and a contemporaneous in-hospital ECPR cohort at the same centre. Secondary endpoints include 30-day survival with favourable neurological outcome assessed blind, decomposition of prehospital pathway intervals, cannulation success, and pre-specified safety endpoints. Enrolment proceeds without prior consent under ethics-approved emergency-research provisions, with deferred consent thereafter.
CONCLUSION: RACE Prague is testing the effect of cannulation location on the time to extracorporeal support and will provide essential evidence on the feasibility of prehospital ECPR.Trial registration:ClinicalTrials.govNCT06789978; Ethics Committee of the General University Hospital in Prague, reference 134/23 S-IV.
METHODS: Single-centre, prospective, interventional, single-arm pilot feasibility study. Twenty adults aged 18-70 years with witnessed refractory OHCA (three unsuccessful defibrillations and/or ≥10 min of resuscitation in pulseless electrical activity), receive prehospital percutaneous femoro-femoral veno-arterial extracorporeal membrane oxygenation (ECMO) from a mobile ECPR team. The primary endpoint (time from estimated collapse to ECMO flow ≥2.0 L/min) is tested hierarchically against the historical Prague OHCA in-hospital ECPR cohort (target shortening ≥15 min) and a contemporaneous in-hospital ECPR cohort at the same centre. Secondary endpoints include 30-day survival with favourable neurological outcome assessed blind, decomposition of prehospital pathway intervals, cannulation success, and pre-specified safety endpoints. Enrolment proceeds without prior consent under ethics-approved emergency-research provisions, with deferred consent thereafter.
CONCLUSION: RACE Prague is testing the effect of cannulation location on the time to extracorporeal support and will provide essential evidence on the feasibility of prehospital ECPR.Trial registration:ClinicalTrials.govNCT06789978; Ethics Committee of the General University Hospital in Prague, reference 134/23 S-IV.