Improving survival in acute myocardial infarction complicated by cardiogenic shock (AMICS) remains a challenge, and mortality remains elevated despite widespread system of care for the management of ST-elevated myocardial infarction (STEMI) leading to high rates of primary percutaneous coronary intervention. In the past decade, the use of mechanical circulatory support (MCS) devices in cardiogenic shock has increased significantly, with observational data showing improve outcomes with the use of pVAD [ , ]. The use of protocols in the treatment of AMICS has shown to be helpful to increase survival [ ]. Recently, the randomized control trial DanGer Shock, demonstrated improved 6-month survival with the use of Impella when compared with standard of care, at an expense of increase risk of vascular complications [ ]. Furthermore, ECLS-SHOCK failed to demonstrate that the use of VA-ECMO in AMICS is better than medical therapy alone with vasopressors and inotropes [ ]. In the same way, ECMO-CS trial showed that immediate ECMO placement in AMICS had similar mortality to early conservative management [ ].