Abstract
With an increasing incidence of cardiogenic shock (CS), mechanical circulatory support is becoming a cornerstone of its management. The primary goal of short-term MCS is to maintain cardiac output and sustain end organ perfusion while reducing cardiac strain in order to allow for optimal cardiac recovery. When used in refractory CS, VA-ECMO certainly restores end-organ perfusion, however it does so at the cost of increasing LV afterload and thereby increasing myocardial demand, in an already damaged or failing myocardium. In recent years, a plethora of techniques have been employed to unload the LV during VA-ECMO to reduce this phenomenon and optimize myocardial recovery.