The intra-aortic balloon pump (IABP) has traditionally been the dominant mechanical circulatory support (MCS) device used in critically ill patients with cardiac disease for a long time because of its ease of implantation and use, low complication rates, and limited available alternatives. Over the past two decades, however, alternative MCS devices that provide superior hemodynamic support have been developed. These devices include axial flow pumps such as Impella® (Abiomed Inc., Danvers, Massachusetts), left atrial-to-femoral arterial ventricular assist devices such as TandemHeart (Cardiac Assist Inc., Pittsburgh, Pennsylvania), and venoarterial extracorporeal membrane oxygenation (VA-ECMO) [ ]. With these devices' availability, the use of IABP has somewhat decreased and the uptake of these alternate MCS devices has increased, especially in the developed world. However, these devices are not widely available, especially in third-world countries, and therefore, IABP still remains broadly prevalent and an important tool in the interventionalists' armamentarium.