Criticalcardiogenicshockremainsaproblemwithstaggeringmortality,withthebesthopeofsurvivaldependingontimelyandaggressiveintervention.Thisoftenrequirestheuseofextracorporealmechanicalsupportinadditiontovasoactivemedicationstomanagepatientsthroughtheirinitialinsult.Thedecisiontousesuchsupportmustbemadeearlyintheclinicalpresentation,andisbestdoneinamultidisciplinaryfashion.Inthisarticle,wereviewtheliteratureandprovideanalgorithmforthetreatmentofcardiogenicshock.