Cardiogenic shock remains one of the most formidable challenges in cardiovascular medicine, with persistently high mortality despite advances in reperfusion and critical care. The lack of large, randomized trials has historically hindered evidence-based decision-making, as emergency presentations and ethical barriers limit enrollment. In response, our group established the Korean Cardiogenic Shock Working Group and published the first guidebook in 2021, thereby fostering structured education and promoting collaborative clinical practice. Through the RESCUE I and II registries, as well as the RESCUE-NIH observational platform, we established a nationwide multicenter infrastructure to systematically capture epidemiology, practice patterns, and outcomes of cardiogenic shock in real-world settings. Building upon these foundations, the ongoing RESCUE-SHOCK randomized trial investigates optimal revascularization strategies in patients with acute myocardial infarction complicated by shock, enrolling participants from more than 30 tertiary centers. In parallel, the REDUCE ECMO trial explores early versus conventional initiation of renal replacement therapy in patients receiving extracorporeal membrane oxygenation, addressing critical gaps in the management of cardiorenal syndrome in shock.

<Ongoing Mechanical Circulatory Support trials>

Our investigations also extend to the optimal use of vasoactive agents, the development of objective measures such as the Vasoactive Inotropic Score, and a critical evaluation of mechanical circulatory support (MCS) devices, including ECMO and Impella, with an emphasis on patient selection, timing, and complication management. These studies underscore the need to view MCS not as a cure, but as a bridge to opportunity, highlighting the importance of critical care practices that mitigate bleeding, infection, and limb ischemia. This lecture will trace the trajectory of these research endeavors—spanning registry development, randomized clinical trials, and international collaborations—demonstrating how challenges have been transformed into opportunities for scientific advancement. By integrating clinical experience with multidisciplinary collaboration, we aim to pave the way toward a more evidence-based, patient-centered future in the care of cardiogenic shock.