The use of temporary mechanical circulatory support (MCS) in the management of refractory cardiac arrest and acute myocardial infarction complicated by cardiogenic shock (AMICS) has changed dramatically over the last decade. While the use of intra-aortic balloon pump for AMICS in some countries has virtually ceased, the use of percutaneous micro axial flow pumps (mAFP) and venoarterial extracorporeal membrane oxygenation (VA-ECMO) has increased worldwide.1, 2 Cardiogenic shock is a syndrome defined by hypoperfusion due to cardiac failure despite adequate ventricular filling, representing a situation where the heart pivotal role to deliver oxygenated blood to the body is failing triggering a vicious circle of organ failure and systemic inflammation. This is a complex heterogeneous and haemodynamically challenging condition, not infrequently difficult to diagnose and certainly not easy to treat. In a situation with imminent or overt haemodynamic collapse due inadequate cardiac output, restoration of flow using MCS seems intuitive. In some patients MCS seems immediate lifesaving with stabilization of haemodynamics and maybe even recovery of heart function, while in others multiorgan failure continues to develop despite adequate device performance. Equipoise exists to the benefit of use of these devices, but the use continues to increase.