Since the U.S. Food and Drug Administration’s approval of the Impella 2.5 L device in 2008, several newer and more robust pumps have been introduced, including the Impella CP, RP device (for right ventricular failure), and 5.0 and 5.5L transaxillary left ventricular pumps, the latter two of which are approved for use up to 14 days. The concept of “unloading” the failed ventricle and providing increased forward flow in the setting of cardiogenic shock is central to the proposed benefit of these pumps. Because of the relative ease of use, the utilization of these devices has exponentially increased over the past few years. While these devices are also approved for “high risk” percutaneous coronary intervention (PCI), their use in cardiogenic shock patients has been questioned in two very recent analyses. Cardiogenic shock remains a fatal disease, and while multiple studies have demonstrated almost instantaneous and superior hemodynamic effects of these devices compared with the intra-aortic balloon pumps, mortality remains in the range of 40% to 60%. Further, there are no convincing “real world” or randomized data (three trials with fewer than 100 patients) to demonstrate a survival benefit of these devices.