Left ventricular (LV) pressure-volume loops showing differential hemodynamics states (black loop indicating physiological patterns), of cardiogenic shock associated to short-term circulatory support with microaxial-flow pump (Impella®), extracorporeal membrane oxygenation (ECMO) or combination of both. In cardiogenic shock related to myocardial infarction, both end-systolic and end-diastolic pressure-volume relationship (red dotted lines) are impaired, along with stroke volume (red dotted loop). Impella® (blue dotted loop) sends blood flow from the ventricle to the aorta and decreases LV pressure, LV size and LV wall tension. Veno-arterial ECMO provides counterflow support into the systemic circulation, leading to an increase in LV pressure, LV size and LV wall tension (Green dotted loop). Combining Impella® with VA-ECMO (purple loop) allows an increase in cardiac output associated to a simultaneous decrease in LV size, LV pressure, and LV wall tension. ESPVR, End-Systolic Pressure-Volume Relationship; EDPVR, End-diastolic Pressure-Volume Relationship.