Cardiac arrest outcomes remain historically poor with survival to hospital discharge less than 2.2% in the UK (Perkins et al, 2018). Refractory cardiac arrest is characterized by a persistent loss of circulation despite resuscitation, with each additional minute of cardiopulmonary resuscitation (CPR) leading to increased mortality and poorer functional outcomes in survivors (Chai et al, 2023). With limited progress in interventions to improve outcomes, extracorporeal cardiopulmonary resuscitation (ECPR) offers a potentially revolutionary treatment for this condition. In this article we will review the evidence and equitable delivery of ECPR in the context of the principles of the United Kingdom healthcare system for a general medical audience.