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IntroductionThe mortality of patients with mechanical complications following myocardial infarction is high. Surgical repair is challenging due to the fragility of ischemic myocardial tissue. The course is frequently complicated by cardiogenic shock, acute kidney injury and respiratory failure.Case reportWe present a patient with out-of-hospital cardiac arrest due to myocardial infarction and left ventricular free-wall rupture, who received extracorporeal cardiopulmonary resuscitation (ECPR), early surgical repair and prolonged veno-arterial extracorporeal membrane oxygenation (VA ECMO) support. The physical outcome of the patient was good with satisfactory exercise tolerance (NYHA II) and there were no neurological deficits following ECPR.DiscussionIn select cases, VA ECMO can be an option to stabilize patients before and after surgical repair to allow for myocardial scarring and hemodynamic recovery. Advanced hemodynamic monitoring should be considered during the run and weaning from ECMO.ConclusionCases of free-wall rupture and cardiogenic shock are challenging and multidisciplinary teamwork of cardiac surgeons, cardiologists, intensivists and nurses is indispensable.