A randomized trial published in the European Heart Journal found that prophylactic micro-axial flow pump support was noninferior to veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with severely reduced left ventricular ejection fraction undergoing high-risk percutaneous coronary intervention (PCI). These findings suggest that the micro-axial flow pump is an effective alternative for providing hemodynamic support during complex high-risk PCI procedures. Randomization was performed between the use of SynFlow 3.0 micro-axial flow pump and conventional VA-ECMO for hemodynamic assistance before the intervention in a one-to-one ratio. To conclude, the preventive use of the micro-axial flow pump during PCI procedures considered at high risk was not inferior to that of the VA-ECMO in the number of major adverse events during 30 days after the intervention. The micro-axial flow pump usage resulted in shorter hospital stay after the procedure.