The abstract discusses the establishment of an Extracorporeal Cardiopulmonary Resuscitation (ECPR) program in a high-volume extracorporeal membrane oxygenation (ECMO) center, emphasizing patient selection and outcome optimization. Despite lacking a 24/7 ECPR program, the center successfully evaluated and cannulated an in-hospital cardiac arrest patient during resuscitation, leading to survival, while an out-of-hospital cardiac arrest patient, considered a poor candidate for ECPR, did not survive despite ECMO center resources.