Introduction: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides benefit to patients in refractory cardiac arrest and cardiogenic shock. However, VA-ECMO elevates LV afterload and causes pulmonary edema and LV distension. Additional IABP support has been recommended in Japan to reduce LV afterload. Alternatively, transcatheter left ventricular assist device, Impella has been recently introduced. However, it remains to be evaluated if there is clinical benefit of concomitant use of VA-ECMO and Impella (ECPELLA). Methods: Aim of this single-site cohort study is to assess the effects of ECPELLA as compared with ECMO with IABP in patients who were managed with VA-ECMO due to refractory cardiogenic shock including cardiac arrest. Results: We retrospectively reviewed 253 consecutive patients, who received VA-ECMO from January 2012 to May 2022 in our institute. Among them, 67 patients who were managed with VA-ECMO alone were excluded. Patients were divided into two groups, ECEPLLA (n=68) and ECMO with IABP (n=118). We applied propensity score analysis with 1:1 score matching using dependent variables of age, the rate of sex, acute coronary syndrome, out-of-hospital and in-hospital cardiac arrest, and extracorporeal cardio-pulmonary resuscitation. We assessed 30-day survival rate, hemodynamic data, and safety profiles including acute kidney injury, blood transfusion and embolic cerebral infarction. Results: Following propensity score matching, 60 ECPELLA and 60 ECMO with IABP patients were included for analysis. The 30-day survival was significantly higher with ECPELLA group compared with ECMO with IABP group (ECPELLA: 48% vs. ECMO with IABP: 28%, p= 0.01, log-rank test). There were no statistical differences in ECMO weaning rate and safety profiles between treatment groups. Conclusions: ECPELLA may be associated with improved 30-day survival in patients with refractory cardiac shock including cardiac arrest.