BACKGROUND Advances in ECMO have rapidly progressed in recent years; however, the clinical mortality rate remains high. This study aimed to identify the risk factors of ECMO in patients with cardiogenic shock. METHODS Data of patients with cardiogenic shock who received ECMO from January 2006 to August 2013 at the Affiliated Hospital of Sun Yat-Sen University were retrospectively analyzed. All patients with cardiogenic shock were divided into two groups according to whether death occurred in the hospital. The possible prognostic risk factors of ECMO were first obtained in a univariate analysis of the two groups, and the risk factors that affected the prognosis of patients who underwent ECMO were determined using a logistic regression analysis. RESULTS This study included 94 cardiogenic shock patients who were treated with ECMO. Overall, 59 patients were successfully weaned from ECMO, which accounted for 62.7% of all patients. The multivariate analysis indicated that the independent risk factors associated with prognosis included ECMO timing (OR = 7.68; 95% CI 1.60-37.01), the occurrence of postoperative MOF (OR = 2,823.09; 95% CI 14.75-540,171.06), and the lactate level at weaning (OR = 493.17; 95% CI: 1.55-156,653.27). CONCLUSION For patients with refractory cardiogenic shock, the early establishment of ECMO, improvement in perfusion, and the prevention of complications may improve the prognosis.