Cardiogenic shock patients represent a wide spectrum of disease that requires tailored therapy to improve hemodynamic derangements. Hemodynamic and metabolic variables are fundamental to any classification scheme for cardiogenic shock. Any attempt to improve outcomes in cardiogenic shock should begin with early identification. Careful consideration when choosing a device and a watchful eye, assessing for complications and response, are needed when caring for patients requiring MCS. Intra-aortic balloon pump (IABP) therapy remains the safe first-line MCS option.