Extracorporeal support can provide a circulation of oxygenated blood in order to restore, improve or maintain tissue perfusion. Established uses include cardiopulmonary bypass to enable cardiac surgery and extracorporeal membrane oxygenation (ECMO) during the treatment of acute lung injury. Advances such as smaller portable pump devices and refinements to circuits, anticoagulation and vascular access have made the emergency use of extracorporeal support feasible both in-hospital and out-of-hospital.1 Numerous small observational studies show that extracorporeal cardiopulmonary resuscitation (eCPR) for cardiac arrest is associated with improved survival when there is a reversible cause for cardiac arrest (eg, myocardial infarction (MI), pulmonary embolism, severe hypothermia).2–4 By restoring tissue perfusion, eCPR potentially increases the time window for achieving a restoration of spontaneous circulation (ROSC) by enabling treatments such as percutaneous …