This HWC 2026 session deals with the clinical issues and changing strategies in the treatment of cardiogenic shock, cardiac arrest, and use of mechanical circulatory support (MCS) systems. Some of the topics of emphasis are early identification of shock, optimized hemodynamic monitoring, current resuscitation strategies, and deployment of devices such as ECMO and Impella in acute care. The session also covers decision rules for starting and weaning support, along with patient outcomes and resource use considerations in critical care cardiology.