Cardiogenic shock (CS) is a life-threatening condition characterized by low cardiac output and sustained tissue hypoperfusion, leading to end-organ dysfunction and death. It is associated with high short-term mortality, and its management remains challenging despite recent advances in therapeutic options. Timely diagnosis and multidisciplinary team-based management have shown favorable outcomes. This review aims to summarize evidence-based practices for managing patients with ischemic and non-ischemic CS, detailing the multi-organ supports needed in this critically ill population. CS has various underlying causes, with acute myocardial infarction (AMI) being the most common. Other causes include de novo subtypes of CS, such as fulminant myocarditis, right ventricular failure, Takotsubo syndrome, post-partum cardiomyopathy, and end-stage valvular heart disease. Despite advances in cardiovascular care, survival of CS patients remains around 50% at 30 days following diagnosis. CS is classified into different stages based on hemodynamic parameters and phenotypes, such as non-congested, cardiorenal, and cardiometabolic. These classifications help in understanding the severity and guiding treatment. The pathophysiology of CS involves an imbalance between input and demand, leading to systemic hypoperfusion and organ dysfunction. It also involves microcirculatory changes, inflammatory activation, anaerobic metabolism, and oxidative stress, contributing to end-organ dysfunction. The management of CS includes coronary artery revascularization, valvular disease management, arrhythmia and conduction disorders management, and mechanical ventilation. Inotropes and vasopressors are used to improve tissue perfusion and pump function. Mechanical ventilation is essential for patients with acute respiratory failure, and positive pressure ventilation (PPV) is recommended to improve gas exchange and reduce work of breathing. Renal replacement therapy is often required in patients with CS due to acute kidney injury. Acute mechanical circulatory support (aMCS) is considered when urgent hemodynamic stabilization is needed, allowing for heart recovery or end-organ protection. The use of aMCS devices, such as Impella or VA-ECMO, is based on the patient's condition and local expertise. In conclusion, the management of CS requires a multidisciplinary approach, including timely diagnosis, appropriate treatment strategies, and close monitoring. The goal is to improve outcomes and reduce mortality in these critically ill patients.Cardiogenic shock (CS) is a life-threatening condition characterized by low cardiac output and sustained tissue hypoperfusion, leading to end-organ dysfunction and death. It is associated with high short-term mortality, and its management remains challenging despite recent advances in therapeutic options. Timely diagnosis and multidisciplinary team-based management have shown favorable outcomes. This review aims to summarize evidence-based practices for managing patients with ischemic and non-ischemic CS, detailing the multi-organ supports needed in this critically ill population. CS has various underlying causes, with acute myocardial infarction (AMI) being the most common. Other causes include de novo subtypes of CS, such as fulminant myocarditis, right ventricular failure, Takotsubo syndrome, post-partum cardiomyopathy, and end-stage valvular heart disease. Despite advances in cardiovascular care, survival of CS patients remains around 50% at 30 days following diagnosis. CS is classified into different stages based on hemodynamic parameters and phenotypes, such as non-congested, cardiorenal, and cardiometabolic. These classifications help in understanding the severity and guiding treatment. The pathophysiology of CS involves an imbalance between input and demand, leading to systemic hypoperfusion and organ dysfunction. It also involves microcirculatory changes, inflammatory activation, anaerobic metabolism, and oxidative stress, contributing to end-organ dysfunction. The management of CS includes coronary artery revascularization, valvular disease management, arrhythmia and conduction disorders management, and mechanical ventilation. Inotropes and vasopressors are used to improve tissue perfusion and pump function. Mechanical ventilation is essential for patients with acute respiratory failure, and positive pressure ventilation (PPV) is recommended to improve gas exchange and reduce work of breathing. Renal replacement therapy is often required in patients with CS due to acute kidney injury. Acute mechanical circulatory support (aMCS) is considered when urgent hemodynamic stabilization is needed, allowing for heart recovery or end-organ protection. The use of aMCS devices, such as Impella or VA-ECMO, is based on the patient's condition and local expertise. In conclusion, the management of CS requires a multidisciplinary approach, including timely diagnosis, appropriate treatment strategies, and close monitoring. The goal is to improve outcomes and reduce mortality in these critically ill patients.