Postcardiotomy cardiogenic shock (PCCS) complicates 0.2% to 6% of cardiac operations and is a clinical entity fraught with considerable morbidity and mortality. A previous review of this topic by our group suggested that regardless of device, only 25% of patients survived to hospital discharge. In the interim, newer technologies have entered the clinical arena. Additional contributions have been made to the literature and new databases are collecting data that are likely to provide more robust guidance for the management of these very complex patients. In this review, we update the experience of mechanical support in the PCCS patient and provide a strategy to maximize survival for a patient who develops PCCS in the community cardiac surgery center.