As extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly utilized for refractory cardiac arrest in adults, we learn significantly more about resuscitation in ways that were not applicable, or even available to us, for patients without extracorporeal membrane oxygenation (ECMO) hemodynamic support.¹ This is because ECMO rapidly restores perfusion during cardiac arrest, functionally “forcing” initial hemodynamic survival.^2,3 Ensuring this immediate survival puts clinicians in a position where they must resuscitate, stabilize, identify and treat the otherwise nonsurvivable arrest etiology in patients who otherwise would have died.