In the context of acute myocardial infarction (MI) cardiogenic shock remains a serious complication associated with high mortality. European heart failure guidelines recommend the use of an intra-aortic balloon pump (IABP) as a beneficial adjunct in the supportive management of patients who develop shock following acute MI. Despite the high levels of ‘clinical belief’ in IABP therapy a review of the literature reveals a less than compelling body of evidence to support its use; specifically in reducing 30-day mortality in those treated with percutaneous intervention. Conversely, patients who have received fibrinolytic drug therapy may benefit from the ‘bridging support’ of an IABP, in the absence of immediate and definitive revascularisation. In light of the conflicting evidence surrounding the use of IABP, attention has been drawn to the potential of left ventricular assist devices (LVAD). However, small randomised studies have yet to reveal improved 30-day mortality in patients supported with LVAD compared with IABP, in the context of cardiogenic shock. More critical and individualised consideration is required regarding which patients may benefit from such support systems. This decision-making may be supported by prognostic biomarkers, specifically interleukin-6, which has been correlated with increased mortality in several small cohort studies. Education for nurses surrounding the holistic management of cardiogenic shock and a broader understanding of the complex sequelae is also required.