The use of temporary mechanical circulatory support (tMCS) devices for the treatment of cardiogenic shock has dramatically increased during the last decade. Percutaneous left ventricular assist devices (pVAD) are increasingly being used in the catheterization laboratory during high risk percutaneous coronary interventions (PCI) in patients who present in shock or are at risk of hemodynamic decompensation [ ]. This significant trend has occurred despite the lack of clear evidence demonstrating improved outcomes with these devices and a recognized association with serious device-related adverse events [ ]. Results from the Danish-German Shock (DanGer Shock) trial have recently demonstrated a survival benefit with the use of the Impella CP (Abiomed, Danvers, MA) in patients with STEMI-related cardiogenic shock [ ]. The enthusiasm generated by this landmark trial will like result in further growth in the utilization of pVAD for the treatment on shock in the catheterization laboratory. Therefore, strategies that lead to an amelioration of device-related complications are needed to maximize patient safety.