This is the third in the series of crisis manuals by Leeuwin Press. It consists of a collection of cognitive aids characterized by enumerated actions to guide the perfusionist in crisis management. The manual is written by three anesthesiologists with 60+ years of cardiac anesthesia, ECMO, and perfusion experience, and they worked with perfusionists Pragnesh Joshi, Ann Ngui, Mark Snider, Anton Van Niekerk, Ken Williams, Paul Rodoreda, Kristine Wardle, Warren Pavey, and Ross Baker to simulate the crisis scenarios. The goal of the manual is to minimize error-prone human factors by emphasizing resource management with a print layout based on aviation checklist design. This approach reduces the cognitive load for perfusionists managing a time-critical event. In other words, unnecessary actions are removed from the working memory and only those actions needed to solve problems are utilized. The cover color is a transition from dark to bright red, like venous and arterial blood, designed to catch the eye in a crisis. There is no table of contents. Instead, there is an index of colored tabs and bulleted directives designed to lead the eye quickly to the necessary crisis intervention checklist. This minimalist layout provides an intuitive design that is a cognitive aid in crisis management. The authors state that the interventions were written following evidence-based guidelines, when available. Otherwise, they were supported by references and professional consensus. However, in keeping with the simplistic approach, there are no sources cited. Lastly, the interventions were tested in crisis simulations. The first section, “HEART & GREAT VESSELS”, contains eight crisis checklists including items such as “Aortic Dissections”, “Massive Hemorrhage with Redosternotomy”, and “Poor Venous Return”. “MONITORED PARAMETERS” contains nine crisis checklists such as “Failure to Rewarm”, “Hyperkalemia” and “Malignant Hyperthermia”. “BLOOD COMPONENTS” contains eleven parts with “Bleeding Post Bypass”, “Heparin Resistance”, and “Sickle Cell Disease” being three examples. “EQUIPMENT FAILURE” has six parts such as “Circuit Leak”, “Failure to Oxygenate” and “Sudden Arterial Pump Failure”. “EMERGENCY PROCEDURES” has nine parts such as “Emergency Pump Set Up”, “Oxygenator Change Out” and “Unexpected Circulatory Arrest”. Lastly, “ECMO CIRCUIT PROCEDURES” has nine parts with three examples being “Air in Circuit”, “Clotting in Circuit”, and “Low Flow”. In total there are 55 crisis checklists. Most checklists have an addendum in smaller font with additional information about the effects, causes, and management of each crisis. These addenda are intended to be complementary information to be studied well before any actual crisis occurs. For example, in the “Emergency Pump Set Up” checklist, item 3 says “Complete the four critical attachments (FLOP).” FLOP is an acronym explained in the addendum as 1. Flow probe, 2. Level sensor, 3. Oxygen tubing attached to oxygenator and 4. Pressure monitor (circuit arterial line). Aviation checklists work best when there are two pilots: one flying the plane and the second reading the checklist and performing the trouble shooting. So, this tool would work best in an n+1 perfusion program. The scenarios assume the immediate availability of backup pumps and specific disposables and tubing pack design. The checklists themselves are in bold-face type for easy reading, with large spacing between each step if the reader needs to make notations due to local idiosyncrasies. This will be necessary because the steps are based on the authors’ use of specific disposables and equipment. Other programs may want to make modifications to the specific steps outlined. Lastly, there is no focus on how to avoid these crises, many of which are preventable, from occurring in the first place by using pre-emptive management. However, avoiding a crisis is not the purpose of a manual focused on “managing time-critical events”. There is no comparable perfusion safety-oriented manual or book. Perfusion texts primarily deal with the physiology and techniques of perfusion practice. Sometimes they include short troubleshooting sections, but not to the extent and specificity of this manual. In summary, the manual lives up to its goal of providing cognitive support in a perfusion crisis even though they are rare events. Nevertheless, the manual is likely to be used frequently because it provides material for simulation training, teaching, and crisis-management rehearsal. Ideally it will be used as a training tool, especially for students.