A large Paris registry study found that initiating ECPR on scene for refractory out-of-hospital cardiac arrest was associated with roughly double the rate of favorable neurological survival compared with starting ECPR in-hospital. The finding focuses on a workflow decision—where the intervention begins—rather than the device itself. For emergency medicine systems and resuscitation pathways, the signal points to the operational value of earlier deployment. Implementation considerations include protocol standardization, transport strategy, and coordination between emergency medical services and advanced cardiac centers.