Patients with cardiogenic shock (CS) present with critical hemodynamic compromise with low cardiac output (CO) resulting in end-organ dysfunction. Prognosis is closely related to the severity of shock, and treatment of patients with CS is resource intensive. In this review, we consider the current treatment paradigms alongside the evidence that underpins them. The current standard of treatment relies on a feedback mechanism, where small changes in treatment are assessed to see if clinical improvement occurs. This leads to delays that increase time in the shock state. The novel approach described proposes immediate treatment to ameliorate the shock state to "break" the shock spiral as quickly and decisively as possible, suggesting new metrics to measure performance.