A 49-year-old Caucasian male without prior medical history presented with recurrent ventricular fibrillation and anterior ST-segment elevation myocardial infarction. Physical exam demonstrated an intubated and sedated male, who was hypotensive and tachycardic with cool, non-cyanotic extremities. Patient was started on amiodarone, lidocaine, norepinephrine, epinephrine, and vasopressin infusions and taken to the cardiac catheterization laboratory. An Impella CP and Swan-Ganz were emergently inserted. Percutaneous intervention of the left anterior descending artery was performed with a single drug-eluting stent. Over the next 6 h, right atrial to wedge pressure ratios began to rise (0.80), pulmonary artery (PA) pulsatility index dropped (0.75), mixed venous oxygen saturation was 40%, cardiac index was 1.7 L/min/m2 (cardiac power output = 0.6 W), and multiple suction alarms were noted on the Impella CP console. Transthoracic echocardiography demonstrated severe biventricular failure with appropriately positioned Impella CP (Videos 1 and 2). Given the worsening haemodynamics, an Impella RP was inserted and suction alarms stopped; however, cardiac power did not increase, and thus we upgraded to Impella 5.0. The patient stabilized and fluoroscopy demonstrated appropriate pump positions. As the patient was being transferred, suction alarms were noted on the Impella 5.0 console and a dampened placement curve similar to a right ventricular pressure tracing was seen on the Impella RP console. Fluoroscopy demonstrated that the Impella RP catheter had ‘fallen back’ into the right ventricle. Multiple attempts at manual manipulation were unsuccessful, and we elected to use snare-assistance to manoeuvre the pump. A 6-Fr sheath was already in place in the left femoral vein and thus we advanced a 6-Fr multi-purpose (MP) coronary guiding catheter with a 25-mm Amplatz GooseNeck Snare (Medtronic, Minneapolis, MN, USA) into the right atrium. The snare captured the Impella RP pigtail, and then we were able to advance both into the right ventricular outflow tract (RVOT). With the cinched snare, we intentionally prolapsed the MP catheter against the pulmonic valve (PV) and advanced both the Impella RP and the MP catheter across the valve and into the left PA (Video 3). The snare was then released and removed. Thereafter, we had re-established stable haemodynamics without suction alarms. Unfortunately, the patient developed colonic ischaemia and necrosis and family elected for emergent bowel resection. Despite resection, the patient sustained progressive renal and hepatic failure along with septic shock. Due to the poor prognosis, the family elected to withdraw all life-sustaining measures ∼36 h after the initial arrest.