BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR) is a potential intervention for refractory in-hospital cardiac arrest (IHCA). This study aimed to evaluate the outcomes of ECPR in patients with refractory IHCA at a university-affiliated tertiary care center. METHODS We performed a retrospective, observational analysis of an institutional database of adult patients who received ECPR for refractory IHCA from January 2007 to December 2023. The primary endpoint was survival to hospital discharge with a favorable neurological outcome, defined as a Cerebral Performance Category (CPC) score of 1 or 2. Patients with a CPC score of 1-2 were compared to those with a CPC score ≥ 3. RESULTS During the study period, 147 patients received ECPR for refractory IHCA (mean age 51.0 years, 64.6% male). Baseline characteristics were comparable between both groups. Mean no-flow time and low-flow time and the rate of shockable rhythms were comparable between both groups. Eighty-nine (60.5%) patients died during temporary mechanical circulatory support. Among the 56 (38.1%) patients who were weaned from mechanical circulatory support, 24 (16.3%) died before hospital discharge. The overall survival to discharge was 22.4%, with 20.4% achieving a CPC score of 1-2. CONCLUSIONS Owing to the invariably fatal nature of refractory IHCA, ECPR offered a reasonable survival with a favorable neurological outcome in this critically ill patients' population.