Technology continues to expand our ability to manage patients with cardiovascular collapse, either from pump or electrical failure. Patients who are at home with cardiac assist devices may be encountered by prehospital EMS clinicians. Intra-aortic balloon pumps offer hemodynamic support until further definitive cardiac care can be provided. Percutaneous mechanical support devices that are either transaortic or transseptal increase cardiac output while reducing myocardial workload. Extracorporeal membrane oxygenation can completely support patients with both cardiac and respiratory failure. Ventricular assist devices have evolved to be longer-term devices. Advances in technology have created a subpopulation of patients living outside the hospital and dependent on cardiovascular-supporting technology. Depending on the specific assist device, the patient may or may not have a palpable pulse or blood pressure. A coordinated exchange of information between the hospital cardiac team and surrounding EMS agencies is key to the safe and effective treatment and transfer of these patients. EMS clinicians should also be able to recognize devices that support cardiac electrical activity and be able to make an assessment about whether a problem relates to a potential device malfunction. Familiarity with the principles of various devices, an organized approach to assessing patients supported by them, and complete exchange of information with subsequent treatment teams are important factors in optimal EMS care.