The decision on When to implement temporary mechanical circulatory support (MCS) hinges on the patient’s haemodynamic status, and the underlying burden of comorbidity, age, and frailty. Early decision and intervention are probably crucial to prevent multi-organ failure and improve outcomes. The How involves selecting the appropriate device and technique tailored to the patient’s condition. Common devices include intra-aortic balloon pumps, percutaneous ventricular assist devices (pVADs), such as Impella, and veno-arterial extracorporeal membrane oxygenation (V-A ECMO). The choice of device depends on factors such as the severity of cardiac dysfunction, involvement of the right ventricle, underlying aetiology, and the patient’s anatomical and haemodynamic characteristics. A pVAD will unload the heart, while V-A ECMO will often increase afterload. A left ventricular pVAD will require right ventricular function and oxygenation, whereas V-A ECMO is reserved for the most critical scenarios due to its ability to provide both biventricular cardiac and respiratory support. For Whom encompasses a broad range of patients, including those with acute myocardial infarction complicated by cardiogenic shock (CS), decompensated acute de novo or decompensated chronic heart failure, and refractory cardiac arrest. Mechanical circulatory support should be reserved for patients with a potential reversible cause of CS and patients who are potential candidates for heart transplantation or those requiring a bridge to more definitive therapy. Effective use of temporary MCS necessitates a multidisciplinary approach involving a shock team¹⁰