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Summary: Extracorporeal cardiopulmonary resuscitation (ECPR) in patients with prolonged or refractory out‐of‐hospital cardiac arrest (OHCA) is likely to be beneficial when used as part of a well developed emergency service system.ECPR is technically challenging to initiate and resource‐intensive, but it has been found to be cost‐effective in hospital‐based ECPR programs.ECPR expansion within Australia has thus far been reactive and does not provide broad coverage or equity of access for patients.Newer delivery strategies that improve access to ECPR for patients with OHCA are being trialled, including networked hospital‐based ECPR and pre‐hospital ECPR programs. The efficacy, scalability, sustainability and cost‐effectiveness of these programs need to be assessed.There is a need for national collaboration to determine the most cost‐effective delivery strategies for ECPR provision along with its place in the OHCA survival chain. [ABSTRACT FROM AUTHOR]

Objective: To describe on‐scene times for out‐of‐hospital cardiac arrests (OHCA) transferred to hospital, the number of these that were extracorporeal cardiopulmonary resuscitation (ECPR) eligible and potential association between end‐tidal carbon dioxide (ETCO2) and survival so as to inform planned interventional studies. Methods: Prospective cohort study of all OHCA, of suspected medical cause, where resuscitation was commenced and who were transported to participating hospitals from October 2020 to May 2021. Results: One hundred and forty‐nine OHCA were included. Forty‐four (30%) patients survived to hospital discharge. Eighteen (8%) met ECPR inclusion criteria. Median on‐scene time was 33 min (interquartile range [IQR] 24–44). Initial hospital ETCO2 for non‐survivors was 35 mmHg (IQR 19–50), survivors 36 mmHg (IQR 33–45); P = 0.215. No patient with an ETCO2 less than 20 mmHg on hospital arrival to survived to hospital discharge. Conclusions: Average on‐scene time did not differ on survivorship. A small number of transferred patients with OHCA were ECPR eligible. ETCO2 less than 20 mmHg portends adverse prognosis. Our data will be used for future interventional studies. [ABSTRACT FROM AUTHOR]