BACKGROUND: The effectiveness of the presence of a prehospital physician for patients with out-of-hospital cardiac arrest (OHCA) undergoing extracorporeal cardiopulmonary resuscitation (ECPR) remains unknown. METHODS: In this multicenter, retrospective, observational study, we enrolled patients aged ≥18 years who developed OHCA and received ECPR. The primary outcome was the 1-month favorable neurological outcome. We estimated the impact of the presence of a prehospital physician on outcomes using a propensity score analysis with inverse probability weighting. RESULT: We enrolled 1,269 patients. favorable neurological outcomes occurred in 25 of 316 (7.9%) patients with prehospital physicians and 94 of 953 (9.9%) patients without prehospital physicians. In the propensity score analysis, favorable neurological outcomes did not differ between two groups (odds ratio = 0.72; 95% confidence interval: 0.44-1.17). CONCLUSIONS: The 1-month favorable neurological outcome was not associated with the presence of a prehospital physician for patients with OHCA who underwent EPCR.