Intra-aortic balloon counterpulsation (IABC) is a widely used form of mechanical circulatory assistance. We have successfully employed IABC in three patients with refractory cardiogenic shock secondary to cardiac contusion. All patients had multiple blunt injuries with cardiac contusion documented electrocardiographically, by CPK isoenzyme determinations, and clinically. IABC was instituted for hypotension refractory to vasoactive drugs and optimization of intravascular volume status. Cardiac output and blood pressure rose in all cases and fewer ventricular arrhythmias were noted. Discontinuation of IABC was possible within 48 hours in all cases with adequate cardiac performance. We conclude that IABC is a useful approach in the treatment of refractory cardiogenic shock associated with cardiac contusion.