<p>Although the changes in the chemistry of seawater driven by the uptake of CO2 by the oceans have been known for decades, research addressing the effects of elevated CO2 on marine organisms and ecosystems has only started recently (see Chapter 1). The first results of deliberate experiments on organisms were published in the mid 1980s (Agegian 1985) and those on communities in 2000 (Langdon et al. 2000; Leclercq et al. 2000 ). In contrast, studies focusing on the response of terrestrial plant communities began much earlier, with the first results of free-air CO2 enrichment experiments (FACE) being published in the late 1960s (see Allen 1992 ). Not surprisingly, knowledge about the effects of elevated CO2 on the marine realm lags behind that concerning the terrestrial realm. Yet ocean acidification might have significant biological, ecological, biogeochemical, and societal implications and decision-makers need to know the extent and severity of these implications in order to decide whether they should be considered, or not, when designing future policies. The goals of this chapter are to summarize key information provided in the preceding chapters by highlighting what is known and what is unknown, identify and discuss the ecosystems that are most at risk, as well as discuss prospects and recommendation for future research. The chemical, biological, ecological, biogeochemical, and societal implications of ocean acidification have been comprehensively reviewed in the previous chapters with one minor exception. Early work has shown that ocean acidification significantly affects the propagation of sound in seawater and suggested possible consequences for marine organisms sensitive to sound (Hester et al . 2008). However, sub sequent studies have shown that the changes in the upper-ocean sound absorption coefficient at future pH levels will have no or a small impact on ocean acoustic noise (Joseph and Chiu 2010; Udovydchenkov et al . 2010). The goal of this section is to condense the current knowledge about the consequences of ocean acidification in 15 key statements. Each statement is given levels of evidence and, when possible, a level of confidence as recommended by the Intergovernmental Panel on Climate Change (IPCC) for use in its 5th Assessment Report (Mastrandrea et al. 2010).</p>