Objective To explore the practical dilemmas in the standardized operation of extracorporeal cardiopulmonary resuscitation（ECPR） team in the emergency department of a tertiary hospital，and to provide a reference for improving standardized operational strategies. Methods A phenomenological research method was adopted. From October to December 2025，18 physicians and nurses involved in ECPR implementation in the emergency department of a tertiary hospital in Jiangsu Province were selected by purposive sampling following the principle of maximum variation sampling for semi-structured interviews. Data were analyzed using Colaizzi’s seven-step method. Results Four themes and 11 subthemes were identified：difficulty in fully implementing standardized procedures under intense time pressure and complex situations；long-term shortage of human resources and heavy workload of medical staff；a training system emphasizing technical operation over systematic competence and an imbalanced competency structure；and prominent psychological stress among medical staff in high-risk，high-cost decision-making situations. Conclusion The standardized operation of emergency department ECPR teams in tertiary hospitals faces practical challenges，including insufficient adaptation to emergency contexts，poor coordination across multiple departments，inadequate staffing and team echelon support，insufficient training support，and lack of psychological support. In promoting standardized operation，hospitals should further optimize key procedures and equipment preparation on the basis of existing technical standards，improve multidisciplinary collaboration and closed-loop information mechanisms，strengthen workforce echelon development and tiered training，emphasize communication with patients and their families，and incorporate psychological support into team building，so as to enhance procedural executability and operational sustainability.