Extracorporeal cardiopulmonary resuscitation (ECPR) is a time-critical, resource-intensive intervention used in select cases of refractory cardiac arrest. Its success depends on rapid initiation, streamlined workflows, and coordination across multidisciplinary teams. This article outlines the phases of ECPR, key resuscitation modifications, and inclusion criteria. It also provides practical guidance on equipment, personnel roles, environmental setup, and post-initiation priorities.