Abstract / Summary
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.gov NCT06789978 ; Ethics Committee of the General University Hospital in Prague, reference 134/23 S-IV.