When a disease state causes shock – hypotension that is not readily reversible with simple manoeuvres, such as heart rhythm control, or correction of hypovolaemia - the chances of an adverse outcome are typically multiplied by an order of magnitude or more, whatever the precipitant of that portentous state [ ]. In cardiology, we have walked a long road, seeking new treatments for cardiogenic shock caused by myocardial infarction (MI), with much attention, congratulation and pathway revision triggered by the results of the DANGERSHOCK randomised trial of the use of a microaxial flow pump to treat acute MI causing shock [ ]. Such are the dismal outcomes in shock caused by MI, that much was made of reducing six-month mortality rates from 58.4 % in the standard of care arm, to 45.8 % in the group that routinely received the cardiac support device. This is not to underestimate the importance and difficulty of the achievement of the DANGERSHOCK investigators. Rather, it focuses the mind on the appalling residual risk experienced by patients who make it to hospital alive, and near 1 in 2 still die as a consequence of cardiogenic shock.