Cardiogenic shock (CS) is a life-threatening condition characterized by low cardiac output and sustained tissue hypoperfusion, often leading to end-organ dysfunction and death. Despite recent advancements in therapeutic options, CS remains challenging to manage, with a high short-term mortality rate. Timely diagnosis and multidisciplinary team-based management have shown favorable outcomes. This review aims to detail evidence-based practices for managing patients with ischemic and non-ischemic CS, emphasizing the need for multi-organ support in critically ill patients. ** Definitions and Classifications:** CS is defined by peripheral hypoperfusion and organ dysfunction due to cardiac dysfunction. The Society for Cardiovascular Angiography and Interventions (SCAI) classification describes five stages of CS, from preshock to extremis, while other classifications focus on hemodynamic parameters or phenotypes. ** Pathophysiology:** CS involves several pathophysiologic mechanisms, including microcirculatory changes, inflammatory activation, and oxidative stress. Distinguishing between acute and chronic CS is crucial, as mortality is higher in acute CS. Acute-on-chronic heart failure evolves into a multisystem disorder, with progressive congestion leading to organ dysfunction. ** Epidemiology:** CS accounts for 7-10% of ICU admissions, with a 30-day mortality rate of around 50%. Data suggest that non-AMI-CS may have better survival rates compared to AMI-CS. Acute cardiac conditions are strong markers of mortality. ** Management:** - **Assessment and Diagnosis:** Multimodal approach including clinical examination, echocardiography, and invasive hemodynamic assessment. - **Monitoring:** Early basic monitoring followed by advanced monitoring in complex cases, including lactate levels, echocardiography, and hemodynamic parameters. - **Coronary Artery Revascularization:** Emergent revascularization is crucial, with primary PCI recommended as first-line therapy. The optimal timing of further revascularization in multivessel disease remains unclear. - **Arrhythmia and Conduction Disorders:** Management includes restoration of sinus rhythm, rate control, and specific treatments for high-degree conduction disorders. - **Valvular Disease:** Management is challenging, with cardiac surgery being the gold standard but invasive. Percutaneous interventions are increasingly used. - **Inotropes/Vasopressors:** Early use of vasopressors to increase perfusion pressure. Norepinephrine is recommended as first-line vasopressor. - **Mechanical Ventilation:** Positive pressure ventilation (PPV) is essential for respiratory distress, with non-invasive ventilation (NIV) and intubation strategies depending on hemodynamic stability. - **Renal Replacement Therapy:** Early initiation of RRT is associated with improved outcomes, but timing depends on specific criteria. - **Acute Mechanical Circulatory Support:** Short-term MCS can be considered for urgent hemodynamic stabilization, with VA-ECMO showing mixed results in randomizedCardiogenic shock (CS) is a life-threatening condition characterized by low cardiac output and sustained tissue hypoperfusion, often leading to end-organ dysfunction and death. Despite recent advancements in therapeutic options, CS remains challenging to manage, with a high short-term mortality rate. Timely diagnosis and multidisciplinary team-based management have shown favorable outcomes. This review aims to detail evidence-based practices for managing patients with ischemic and non-ischemic CS, emphasizing the need for multi-organ support in critically ill patients. ** Definitions and Classifications:** CS is defined by peripheral hypoperfusion and organ dysfunction due to cardiac dysfunction. The Society for Cardiovascular Angiography and Interventions (SCAI) classification describes five stages of CS, from preshock to extremis, while other classifications focus on hemodynamic parameters or phenotypes. ** Pathophysiology:** CS involves several pathophysiologic mechanisms, including microcirculatory changes, inflammatory activation, and oxidative stress. Distinguishing between acute and chronic CS is crucial, as mortality is higher in acute CS. Acute-on-chronic heart failure evolves into a multisystem disorder, with progressive congestion leading to organ dysfunction. ** Epidemiology:** CS accounts for 7-10% of ICU admissions, with a 30-day mortality rate of around 50%. Data suggest that non-AMI-CS may have better survival rates compared to AMI-CS. Acute cardiac conditions are strong markers of mortality. ** Management:** - **Assessment and Diagnosis:** Multimodal approach including clinical examination, echocardiography, and invasive hemodynamic assessment. - **Monitoring:** Early basic monitoring followed by advanced monitoring in complex cases, including lactate levels, echocardiography, and hemodynamic parameters. - **Coronary Artery Revascularization:** Emergent revascularization is crucial, with primary PCI recommended as first-line therapy. The optimal timing of further revascularization in multivessel disease remains unclear. - **Arrhythmia and Conduction Disorders:** Management includes restoration of sinus rhythm, rate control, and specific treatments for high-degree conduction disorders. - **Valvular Disease:** Management is challenging, with cardiac surgery being the gold standard but invasive. Percutaneous interventions are increasingly used. - **Inotropes/Vasopressors:** Early use of vasopressors to increase perfusion pressure. Norepinephrine is recommended as first-line vasopressor. - **Mechanical Ventilation:** Positive pressure ventilation (PPV) is essential for respiratory distress, with non-invasive ventilation (NIV) and intubation strategies depending on hemodynamic stability. - **Renal Replacement Therapy:** Early initiation of RRT is associated with improved outcomes, but timing depends on specific criteria. - **Acute Mechanical Circulatory Support:** Short-term MCS can be considered for urgent hemodynamic stabilization, with VA-ECMO showing mixed results in randomized