A retrospective observational study in a single Swiss center investigated the long-term neurological outcome in 578 patients with out-of-hospital cardiac arrest (OHCA) transferred to hospital between 2015–2023. A total of 19.7% of patients (95% CI: 16.6–23.2%) achieved a favorable neurological outcome at 1 year, 16.8% (95% CI: 12.1–22.4%) before ECPR implementation and 21.5% (95% CI: 17.4–26.1%) after it. Implementation of ECPR for patients with refractory OHCA was not associated with better 1-year neurologic outcome. Of the 578 patients, 16.8% (97 patients) met ECPR criteria, with 34 treated with this method and all 5 survivors having a favorable neurologic outcome at 1 year. Factors associated with a higher risk of non-survival were a non-shockable initial rhythm (OR 2.19), older age (OR 1.02), and unwitnessed OHCA (OR 1.68). The study was registered under NCT03759210.