A 58-year-old male presents to the hospital with acute ST-segment elevation myocardial infarction (STEMI) and is brought to the cardiac catheterization laboratory, where he undergoes angioplasty and has an intra-aortic balloon pump (IABP) placed for hemodynamic support. Overnight, the patient becomes increasingly hypotensive with reduced urine output and requires vasopressors. A pulmonary artery catheter (PAC) was placed and indicated elevated pulmonary capillary wedge pressure (25 mm Hg) and reduced cardiac output (CO; 1.8 L/min). Bedside echocardiography showed severe left ventricular dysfunction with severe central mitral regurgitation. Perfusion parameters (low CO, rising lactate, reduced urine output) remain critical despite high doses of ionotropic therapy with epinephrine and dobutamine. Cardiac surgery and interventional cardiology teams were consulted for placement of an Impella heart pump. While in the catheterization laboratory, the patient suffered cardiac arrest with ventricular tachycardia and was emergently placed on peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Over the next several days, the patient's cardiac function did not recover, and he was brought back to the operating room for placement of a left ventricular assist device (LVAD).