The prognosis for ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS) remains dismal, despite treatment with primary percutaneous coronary intervention (PCI). These patients may benefit from mechanical support. In the current report, we describe the history of four STEMI patients with CS, who were bridged to recovery with the Impella percutaneous left ventricular assist device. Patient A was a 46-year-old man who underwent PCI after a period of prolonged resuscitation. After initial stabilization on positive inotropic medication, an Impella 5.0 device was implanted. Patient B was a 57-year-old female who was referred for persistent CS after PCI in a regional hospital, despite positive inotropic medication and intra-aortic balloon pump-treatment. An Impella 5.0 device was implanted upon arrival in hospital. Patient C was a 48-year-old man who underwent Impella 5.0 implantation after PCI and initial Impella 2.5 implantation. Patient D was a 51-year-old man who underwent Impella 2.5 implantation during PCI. Upon presentation, he was not mechanically ventilated. All four patients were eventually discharged home in good clinical condition. Copyright © 2011, Nederlandse Vereniging voor Intensive Care.