Daniel Burkhoff, MD, PhD, discusses the clinical science of cardiogenic shock at the Cardiogenic Shock Working Group (CSWG) Global Summit, held in June of 2023. He briefly reviews randomized trials from the SHOCK trial in 1999 through ECMO-CS in 2022, noting that this data doesn’t support the use of IABP, Impella 2.5®, or ECMO in STEMI shock and there is no guidance for non-STEMI shock. “So is it really the case that none of these devices work?” he asks. “Or is there a problem with the way we have been designing and executing these randomized studies?” Dr. Burkhoff then briefly explores whether there are other ways to meaningfully advance the field, notably through data from observational registries. He concludes with a description of the data being generated by the CSWG, stating, “We hope that you will agree that these data are indeed contributing in a meaningful way to advancing our understanding of shock and therapeutics.”