Extracorporeal cardiopulmonary resuscitation (eCPR) may improve survival and neurologic outcomes in selected patients with refractory cardiac arrest, but evidence remains limited and its use raises significant ethical and resource challenges, according to a review. eCPR can preserve organ perfusion and provide time for diagnosis and decision-making, yet is associated with complications, prolonged intensive care, and complex issues related to autonomy, equity, and organ donation. The authors recommend selective use in experienced centers with careful ethical oversight.