Pediatric patients undergoing cardiac catheterization are at risk of major adverse events, including cardiac arrest and the need for extracorporeal membrane oxygenation support. The primary aim of this study was to characterize the use of extracorporeal cardiopulmonary resuscitation (eCPR) and its outcomes in a large pediatric cardiac catheterization laboratory (PCCL). The secondary aims were to identify key clinical and procedural risk factors associated with eCPR deployment and to assess the utility of novel risk scoring metrics in predicting the need for eCPR. Between January 1, 2000 and December 31, 2023, eCPR occurred in 39 of 29,480 (0.13%) cases in the PCCL, with a statistically significant decrease over time. Most eCPR events occurred during interventional cases and were procedure-related. Extracorporeal cardiopulmonary resuscitation was not limited to those patients with elevated patient- or procedure-specific risk scores. Survival to discharge was 61.5%. Neurological complications were present in 46.2%. Further work will need to concentrate on better understanding which patients are at risk of eCPR in the PCCL and on refining risk scoring metrics to better capture that risk. Enhanced predictive risk modeling has the potential to reduce morbidity and mortality in the pediatric congenital heart disease population.