Viviana Navas, MD, presents the case of a 31-year-old male with extreme shortness of breath and previous diagnoses of pneumonia and cardiomyopathy. This case highlights the importance of consulting with a multidisciplinary shock team and the importance of right heart catheterization (RHC) for monitoring patient hemodynamics. The patient is diagnosed with cardiogenic shock, severe acute biventricular failure, volume overload, and respiratory failure. He is supported with Impella 5.5® and VV ECMO. Despite improvement in pulmonary edema, the patient cannot be weaned from Impella® support and is sent for transplant evaluation.