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Spontaneous coronary artery dissection (SCAD) is a common cause of myocardial infarction in young and middle-aged women. Patients with SCAD present rarely with hemodynamic collapse and cardiogenic shock, requiring immediate resuscitation and mechanical circulatory support. Percutaneous mechanical circulatory support may serve as a bridge to recovery, decision or heart transplantation. We present a case of a young woman with SCAD of the left main coronary artery, presenting with ST-elevation myocardial infarction, cardiac arrest and cardiogenic shock. She was stabilized emergently with Impella and early escalation with extracorporeal membrane oxygenation (ECPELLA) at a non-surgical community hospital. Despite revascularization with percutaneous coronary intervention (PCI), her left ventricular recovery was poor, and ultimately required cardiac transplantation on day 5 of her presentation. • Mechanical circulatory support is key to stabilize patients with refractory cardiogenic shock in order to perform revascularization • Access to mechanical circulatory support in the community and timely escalation of mechanical circulatory support are fundamental to achieve favorable outcomes in cardiogenic shock. • Early evaluation by advanced heart failure team in a tertiary experienced center is recommended. [ABSTRACT FROM AUTHOR]