Between standardization, team processes and targeted cycle support

Cardiogenic shock (CS) is and remains the most dramatic form of acute circulatory failure in cardiology. Despite decades of intensive research, hospital mortality has long remained in the range of 35-50 percent. In 2025, the turning point is less a new “miracle cure” than a new operating system: an internationally uniform language with the SCAI classification, standardized shock pathways, early revascularization according to clear principles, a more cautious view of ECMO, and – following the breakthrough of DanGer-Shock – careful, selective use of microaxial pumps in precisely defined scenarios. Consensus papers and guidelines from 2025 consolidate this paradigm shift: timing, selection and team processes are crucial.