The use of veno- arterial extracorporeal membrane oxygenation as extracorporeal cardiopulmonary resuscitation in patients suffering out- of- hospital cardiac ar-rest, largely increased in the last decade despite evidence supporting this practice being limited to non- randomized studies. However, between 2020 and 2023, four randomized studies were published comparing extracorporeal cardiopulmonary resuscitation to conventional cardiopulmonary resuscitation with controversial findings that triggered great debates. In this controversy, we discuss merits and pitfalls, and provide a critical interpretation of the available evidence from rand-omized trials on the use of extracorporeal cardiopulmonary resuscitation, with a particular focus on the recent multi- center INCEPTION trial.