Out-of-hospital cardiac arrest (OHCA) remains a critical public health challenge with high mortality and poor neurological outcomes. Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a promising intervention for refractory OHCA, offering improved survival and neurological recovery compared with conventional cardiopulmonary resuscitation (CCPR). This expert consensus, developed by the Emergency Medicine Branch of the Chinese Medical Association and the Emergency Medicine Branch of the Guangdong Medical Doctor Association, presents evidence-based recommendations for pre-hospital ECPR implementation in China. Key areas include dispatch protocols, team composition and training, equipment logistics, indications and timing, procedural techniques, and patient transport. The consensus emphasizes initiation of ECPR within 20 minutes of CCPR, establishment of extracorporeal membrane oxygenation within 60 minutes of arrest, and maintenance of high-quality resuscitation during cannulation. Special considerations for unique settings, such as large public events, are also discussed. This document aims to standardize pre-hospital ECPR practices, optimize patient outcomes, and guide healthcare providers in delivering effective extracorporeal life support for OHCA.