Mechanical circulatory support has become an increasingly important therapeutic option in the field of cardiology, both with regard to treatment of patients in cardiogenic shock and protection against haemodynamic instability during high-risk percutaneous coronary intervention (PCI). The intra-aortic balloon pump (IABP) is the current standard treatment for mechanical circulatory support. However, its efficacy seems limited, both in acute and elective settings. The Impella system is a new technique which may be a suitable alternative to IABP treatment. The Impella is a small micro-axial, catheter-mounted cardiac pump, which is inserted through the femoral artery. Safety and efficacy of Impella treatment have been demonstrated during elective high-risk PCI. In the setting of cardiogenic shock, mechanical support with the Impella may lead to partial recovery of left ventricular function, especially when Impella treatment is applied according to a carefully designed pre-specified protocol..