This study explores ECPELLA, combining veno-arterial extracorporeal membrane oxygenation (ECMO) and Impella, for severe cardiogenic shock treatment. Through comprehensive simulation, it examines ECPELLA’s effects on haemodynamics and global oxygen delivery in biventricular failure scenarios. Findings reveal ECPELLA enhances systemic flow and achieves biventricular unloading, with veno-venous ECMO further improving oxygen delivery. Optimizing ECPELLA support is crucial for maximizing benefits in severe cardiogenic shock and acute respiratory failure cases.