This multicenter study analyzed 5,492 patients with cardiogenic shock (CS) treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO). Among them, 15.1% received intra-aortic balloon pump (IABP) for left ventricle unloading after VA-ECMO. The IABP group showed reduced in-hospital mortality (48.0% vs. 52.5%) and improved survival on VA-ECMO. However, increased risks of mechanical, bleeding, renal, and pulmonary complications were observed. Findings suggest IABP may enhance outcomes in CS patients on VA-ECMO but warrant further validation in randomized trials.