OBJECTIVE To provide a contemporary concise overview of the currently available mechanical circulatory support (MCS) devices and the emerging concepts in the management of cardiogenic shock (CS). RESULTS New classification of CS has emerged and is hoped to allow a unified approach to research and clinical management of CS. A number of MCS devices have also become available for clinical use in the last 2 decades. Those devices have different hemodynamic targets, provide various levels of support, and are associated with specific requirements and potential complications. Data on the utility of MCS in CS remains conflicting with randomized trials showing no benefit of MCS, and observational data suggesting an incremental value for MCS over medical therapy. However, the early use and escalation of MCS in a standardized approach do appear to provide a remarkable improvement in short-term outcomes of patients with CS. MCS devices afforded lifesaving treatment for many patients with CS. However, optimal utilization of such devices requires familiarity with their clinical data, and technical characteristics, and mandates their integration in an algorithmic team-based approach to CS.