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Cardiogenic Shock remains one of the deadliest clinical conditions in the world. Despite technological advances, mortality rates remain unacceptably high. While recently published data in acute myocardial infarction-cardiogenic shock (AMI-CS) suggest improved outcomes with protocolized use of early temporary mechanical circulatory support (tMCS) real-world observational and registry data in both AMI-CS and heart failure-related CS suggest opportunities to improve survival through use of shock teams, early escalation to tMCS and use of hemodynamic and hemometabolic monitoring. Here we review current literature on escalation of care in cardiogenic shock and provide recommendations for optimal escalation through organized systems of care.