Marisa Cevasco, MD, a cardiac surgeon at the Hospital of the University of Pennsylvania, presents a case illustrating the use of Impella 5.5 with SmartAssist in a patient on venoarterial extracorporeal membrane oxygenation (VA ECMO)—a combination known as ECpella. The patient is an otherwise healthy 63-year-old male who had chest pain, collapsed and was diagnosed with an anterior STEMI. The patient was emergently transferred to Dr. Cevasco and arrived in profound cardiogenic shock. She started VA ECMO followed by Impella 5.5 to facilitate LV unloading. “I figured this was going to be a long course,” Dr. Cevasco emphasizes with regard to her decision to add Impella 5.5. “This was not going to be someone who would just be able to wean off ECMO.”