“Will there ever be a positive or practice-changing shock trial?” David Morrow, MD, MPH, addresses this question from the cardiac intesivist’s point of view at the Cardiogenic Shock Working Group (CSWG) Global Summit in June 2023. “We have quite a track record of neutral trials,” Dr. Morrow explains, “but it’s not for lack of trying.” Among the barriers to obtaining positive shock trial results, he identifies urgency and mortality, discomfort with equipoise, informed consent challenges, and the heterogeneity of shock. He points to several general critical care studies, and from these studies, he draws key elements for shock trials. He concludes that we have no alternative but to find ways to design positive and practice-changing shock trials. “Observational studies are irretrievably confounded by indication,” he emphasizes, “and will not leave us with an evidence base that we need to change guidelines and to help guide evidence-based practice for this syndrome.”