The use of Extracorporeal Cardiopulmonary Resuscitation (ECPR) in cases of cardiac arrest is increasing, as addressed in the number of cases in the Extracorporeal Life Support Organization (ELSO) dashboard.¹ Of a total 33.000 of ECPR cases, about 50 % were recorded during the last 5 years.¹ Good long-term quality of life and intact long-term neurological and cardiac function after ECPR in out-of-hospital cardiac arrest (OHCA) patients have been reported.^2–6 If these preliminary findings hold, a major paradigm shift might occur soon whether ECPR will be recommended as a standard of care in resuscitation. Is the use of ECPR for OHCA ready for broad implementation?