Papillary muscle rupture is a fatal complication with a high operative mortality rate of 13–40%. Most patients experience cardiogenic shock and hypoxia due to pulmonary edema caused by severe mitral regurgitation. Although preoperative stabilization using a mechanical assist device potentially improves surgical outcomes, an appropriate strategy has not yet been established. ECPELLA is a useful mechanical circulatory support (MCS) strategy, combining venoarterial extracorporeal membrane oxygenation and Impella®, and potentially increases cardiac output and tissue perfusion and improves left ventricular distension and oxygenation in patients with refractory cardiogenic shock. Herein, we present our surgical technique involving the successful management of ECPELLA during surgery in patients with papillary muscle rupture.