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We review the current evidence on the use of pVADs (Tandemheart pVAD, Impella, percutaneous extracorporeal membrane oxygenation), their indications, relative merits, and adverse effects, and discuss the current approach to the appropriate use of pVADs in patients with cardiogenic shock. We also propose an algorithm for device selection tailored to each patient's needs based on severity of cardiogenic shock, amount of support needed, and the overall clinical scenario.