Extracorporeal cardiopulmonary resuscitation (ECPR) involves cannulation and initiation of venoarterial extracorporeal membrane oxygenation, offering enhanced perfusion during refractory cardiac arrest when conventional cardiopulmonary resuscitation fails. The use of ECPR has expanded for both in-hospital and out-of-hospital cardiac arrest settings, with growing evidence supporting improved survival (31% of patients surviving to discharge) and favorable neurologic outcomes (14%). This is especially when implemented within strict time constraints in younger patients with shockable rhythms and with system readiness. This narrative review provides an overview of the historical developments, inclusion criteria, outcomes, complications, ethical issues, and emerging strategies, including prehospital ECPR.