Cardiogenic shock represents the most severe form of acute heart failure syndromes. It is a multi-faceted clinical condition with numerous etiologies that requires management based on several factors such as cardiomyopathy etiology, mono- or biventricular involvement, pattern of congestion, and severity of shock. Non-invasive positive pressure ventilation is universally recognized as a first-line therapy in numerous clinical conditions, including acute cardiogenic pulmonary edema. Despite shock has historically been considered a contraindication to noninvasive ventilation, there is a growing body of evidence that positive pressure noninvasive ventilation may be a safe and effective choice in cardiogenic shock patients. Invasive mechanical ventilation may be a life-saving therapeutic intervention, but it may be associated with numerous complications, which may be life-threatening. With appropriate patient selection, non-invasive ventilation may—and should—be used in cardiogenic shock, avoiding unnecessary invasive mechanical ventilation and its complications. However, intensive care unit staff experience and constant and careful multiparametric monitoring of patients are mandatory to ensure better outcomes.