Cardiovascular resuscitation is a cornerstone of critical care practice. Experimental advances have increased our understanding of the role of the microcirculation in shock states and the development of multi-organ failure. Strategies that target the microcirculation in such conditions, while theoretically appealing, have not yet been shown to impact upon clinical outcomes. This review outlines the current understanding of microcirculatory dysfunction in septic, cardiogenic, and hypovolaemic shock and outlines available treatments and strategies with reference to their effects upon the microcirculation.