We report a case of a 68-year-old woman referred to our hospital after being diagnosed of acute coronary
syndrome with ST elevation but no evidence of coronary stenosis amenable of percutaneous or surgical approach. She was transferred to our institution due to pericardial effusion with incipient haemodynamic compromise and under suspicion of contained cardiac rupture. Pericardial collection was shown in a rutine transthoracic echocardiogram study meanwhile the patient was recovering from coronary event in a different hospital with no Cardiac Surgery facilities. After sternotomy and removal of pericardial fluid, biventricular failure developed with no answer to inotrope support. Venous-arterial extracorporeal membrane oxygenation (VA-ECMO) through femoral vasculature was initiated in few minutes. The outcome of this patient was succesful and biventricular function was completely recovered.