Despite improvement in recent decades, cardiac arrest without resumption of spontaneous circulation in a short time period and advanced cardiogenic shock continue to have a high mortality. Acute mechanical circulatory support devices, including extracorporeal membrane oxygenation, intra-aortic balloon counter pulsation, and intravascular microaxial ventricular assist devices, among others, have become widely used tools available to clinicians in managing these critical conditions. Acute mechanical circulatory support use is compelling as a strategy to secure cardiopulmonary function and serve as a bridge to decision in patients with refractory acute cardiogenic shock and cardiac arrest, however, the evidence and support of their use varies. Here we review acute mechanical circulatory support devices available to clinicians and the current guidelines surrounding their use in cardiac arrest and cardiogenic shock, both for myocardial infarction and heart failure shock etiologies. We further discuss device utilization changes and trends in light of recent evidence and updates to the United States Adult Heart Allocation Policy.