There has been a growth in a population of patients with coronary artery disease for which revascularisation has been precluded by the presence of significant co-morbidities. The use of haemodynamic support devices has helped provide an avenue of treatment for these patients. The first study for the intra-aortic balloon pump (IABP) was first published in 1962 and it has remained a mainstay treatment for cardiogenic shock despite inconclusive evidence and only modest augmentation in cardiac output. The TandemHeart device transports oxygenated blood via a centrifugal pump from the left atrium to the femoral artery. The IABP has grown to be the most widely used haemodynamic support device since its introduction in the 1960s. This device employs the counterpulsation of a balloon in the descending aorta to improve cardiac output and increase coronary perfusion. The haemodynamic consequences of counterpulsation can be organised into those that occur during inflation and those during deflation.