Extracorporeal cardiopulmonary resuscitation for refractory out‐of‐hospital cardiac arrest is increasingly used, with survival rates up to ≈30% reported in select highly organized systems, although outcomes vary widely across programs. However, outcomes are driven largely by system performance rather than the procedure itself. To date, most literature has focused on efficacy, patient selection, and cannulation techniques, with limited emphasis on system‐level design. This narrative review synthesizes the key components required to implement an effective extracorporeal cardiopulmonary resuscitation–enabled cardiac arrest system from optimizing the existing emergency medical services, understanding the expected number and distribution of potential patients undergoing extracorporeal cardiopulmonary resuscitation, using geographic information systems to optimize system design to the value of integrated structured identification pathways, streamlined intra‐arrest transport strategies, coordinated postresuscitation care within specialized cardiac arrest centers, and cost‐effectiveness considerations.