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Excerpt: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used to treat refractory cardiogenic shock (CS) or cardiac arrest (CA) over the past decades. Peripheral VA-ECMO increases left ventricular (LV) afterload, potentially impairing myocardial recovery and leading to poor outcomes. Intra-aortic balloon pump (IABP) has been suggested as an approach to unload LV in patients supported by VA-ECMO [1]. However, the effectiveness of IABP combined with VA-ECMO remains controversial [2,3,4]. Using the data from the Chinese Extracorporeal Life Support (CSECLS) registry, we aimed to evaluate in-hospital outcomes in CS patients who received VA-ECMO with or without IABP.