Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has become an accepted treatment modality for refractory cardiogenic shock (CS). However, its use is limited to tertiary centers due to resource allocation, education, and personnel requirements. The cannulate-and-ship model has therefore emerged to extend access to VA-ECMO. This model faces several communication, education, and logistical challenges. We describe the safety and early outcomes of a regional VA-ECMO training and air medical transport program that uses a text-message-based communication protocol and an “always open” VA-ECMO transfer status. In this retrospective descriptive study, 14 patients were cannulated at rural or limited-resource hospitals and transported by air to a tertiary ECMO center between October 2024 and December 2025. Median transport distance was 440 km. All patients survived transport without transport-related complications. Survival to VA-ECMO decannulation was 86%, to hospital discharge 79%, and 30-day survival from cannulation was 69%. These findings suggest that our structured regional program, incorporating simulation-based training, centralized consultation and communication, and perfusionist-supported transport, may safely extend VA-ECMO access to remote hospitals while addressing communication and logistical barriers.