Extracorporeal Membrane Oxygenation (ECMO) is increasingly used in refractory cardiac and respiratory failure, yet the role of perfusionists remains narrowly defined. While traditionally viewed as technical operators, perfusionists possess advanced expertise that are essential across the continuum of care. Their exclusion from key clinical and academic roles represents a structural gap possibly with implications for safety and outcomes. This letter advocates for redefining perfusionists as clinical stakeholders, formally integrated into decision-making, quality improvement, and research initiatives. Their engagement can enhance ECMO practice across a multitude of areas. Recognizing perfusionists as integral members of the multidisciplinary team is essential to advancing outcomes, and meeting the demands of increasingly complex extracorporeal therapies.