Prof. Dr. Evgenij V. Potapov discusses tailored solutions for treating advanced cardiogenic shock by combining ECLS with pMCS (ECMELLA). He explains how he uses single arterial access for ECMELLA at his institution with case video demonstrating the technique. He then describes the results seen in patients between May 2020 and September 2022 and the algorithm at his institution for temporary MCS device selection in cardiogenic shock. He concludes that axillary implanted Impella heart pumps based temporary MCS is the first choice for patients with severe cardiogenic shock and that an algorithm-based approach for escalation and de-escalation improves survival in patients with severe cardiogenic shock.