Acute cardiogenic shock has a high mortality and rescue with mechanical circulatory support remains the only means of survival in most cases. Over the past decade, an increasing number of assist devices have been developed for both temporary and long-term circulatory support. Different types of devices are placed either percutaneously or surgically in different scenarios. Extracorporeal percutaneous devices are useful for rapid implementation of support aimed at stabilizing the patient's general condition by providing enough systemic circulation and improvement of native heart function to allow removal of the device. Instead of veno-arterial bypass, new percutaneous devices that directly drain the left atrium or ventricle seem a promising option. If recovery is unlikely, further assessment and additional treatment should be considered for longer term support aiming at bridging to transplantation or chronic assistance. Short-term support with extracorporeal devices to bridge the patient to long-term therapies is becoming a more and more important strategy. Paracorporeal pulsatile devices still have an important role for patients requiring biventricular support or in the pediatric population. Chronic support aiming at heart transplantation using a paracorporeal device is an alternative option until the new rotary blood pumps become available in Japan. (Circ J 2009; Suppl A: A-42-A-47)