Ventricular fibrillation/ventricular tachycardia cardiac arrest is a common emergency situation with poor survival. E-CPR is increasingly being adopted as an evolution of ACLS demonstrating increased survival in select patient scenarios. It is very resource intensive, and most feasible for mature ECMO programs. In the Portland metropolitan area, there is an imminent opportunity to collaborate between emergency medical services (EMS), community health partners, and the sponsoring institution to deliver a citywide E-CPR program that triages, transports, and delivers timely care to E-CPR eligible patients. A stepwise implementation of the E-CPR program will ensure that appropriately skilled staff, adequate resources, and financial feasibility are provided to meet the E-CPR need at each phase of the rollout. A mature E-CPR program at the sponsoring institution is considered the backbone of the long-term initiative, in addition to partnerships with EMS and other health systems. Establishing an E-CPR program will provide a financially sustainable, citywide service that will save many lives.