Peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used in refractory cardiogenic shock. However, the retrograde arterial perfusion can result in left ventricular (LV) distention and overloading, which leads to pulmonary edema and failure of LV recovery. Various LV unloading strategies have been utilized, including creation of an LV vent, use of temporary percutaneous left ventricular assist devices, and balloon atrial septostomy (BAS). Of these, BAS is a less common strategy. We sought to assess outcomes of LV unloading with BAS at our center. Thirty-seven patients undergoing VA-ECMO for cardiogenic shock between July 2018 and September 2019 were included in the study. Of these, 7 patients underwent BAS. Three of them had concurrent intra-aortic balloon pump (IABP). These patients all had the IABP inserted prior to VA-ECMO initiation and BAS. Thirty patients underwent either no unloading or unloading with LV venting, the Impella device, or IABP. The causes of cardiogenic shock and pre- and post-BAS left atrial pressures were evaluated, along with outcomes. The causes of cardiogenic shock are listed in the corresponding figure. Of the seven patients who were unloaded with the BAS strategy, three patients recovered, two died, one received an LVAD, and one underwent heart transplant. The patient who underwent LVAD implantation passed away due to post-operative RV failure. One patient in this study was converted from peripheral VA-ECMO to central VA-ECMO. Of the 7 patients, 4 of them had pre- and post-BAS left atrial pressure measured. There was a mean decrease of 5.75 mmHg. Of the patients who underwent other unloading strategies or no venting, thirteen recovered, thirteen died, and four underwent transplant or LVAD implantation. This small, single-center experience suggests that BAS could be a viable strategy of LV unloading. Further investigation needs to be undertaken to better understand patient selection.