Dramatically developing cardiogenic shock is a rare but very important clinical problem. Mostly it is caused by ischaemia of the heart, myocarditis, decompensated chronic heart failure and postcardiotomy syndrome. If this problem is associated with peripheral hypoperfusion and irreversible multiorgan failure, mortality is extremely high despite aggressive medical therapy. The authors describe 7 cases of acute heart failure with cardiogenic shock. In all cases a biventricular mechanical support device (POLVAD) was implanted as a consequence of unsuccessful aggressive medical therapy. Two patients died, three patients reached full recovery and successful weaning from the support device, two patients were bridged to heart transplantations.