Survival on the clock: rethinking where and how we deliver ECPR

Extracorporeal cardiopulmonary resuscitation (ECPR) is the only therapy capable of rescuing patients from refractory cardiac arrest, but its effectiveness is critically dependent on time to reperfusion. The system proposed here, grounded in current physiologic and systems-level evidence, is designed to reliably achieve extracorporeal membrane oxygenation (ECMO) flow within approximately 45 min of collapse. This model emphasizes tightly organized, strike team–like ECPR units, parallel activation pathways, and predefined deployment and transport strategies independent of cannulation location. As ECPR systems evolve, integration of artificial intelligence–enabled dispatch and decision-support tools may further improve reliability, scalability, and equitable access to timely reperfusion.