Left ventricular free wall rupture (LVFWR) is still an uncommon catastrophic complication after acute myocardial infarction (MI), and it is one of the most frequent causes of sudden cardiac death. Immediate surgical repair is the treatment of choice. When LVFWR presents acutely with tamponade and cardiogenic shock in emergency department, salvage with a good outcome is still possible by timely pericardiocentesis and extracorporeal membrane oxygenation (ECMO) support. We report a case of cardiac rupture with tamponade and cardiogenic shock in which cardiopulmonary support with portable ECMO was used to rescue the patient before the operation.