Coastal zones sustain extensive biodiversity, support key processes for ocean dynamics, and influence the balance of the global environment. They also provide resources and services to communities, determine their culture, and are the basis for their economic growth. Cartagena Bay in the Colombian Caribbean is the place of the establishment of one of the country’s main cities, which has a great historical and tourist attraction, and it is also the location of the main commercial port and a great variety of industries. Historically, it has been affected by several environmental impacts and intense pollution. This situation has gained the attention of different researchers, so herein is presented a literature review with a systematic approach using RStudio’s bibliometrix on the presence of pollutants and the impact on biodiversity in recent decades, providing a critical analysis of the state of Cartagena Bay and its future needs to ensure its recovery and conservation. In addition, the socioeconomic dynamics related to the environmental state of Cartagena Bay are presented from the framework drivers, pressures, status, impacts, and responses (DPSIR). The update and critical understanding of the sources, fate, and effects of pollution are important not only for the knowledge of the status of this singular ecosystem but also to encourage future research and entrench evidence to support decision makers’ actions. This review highlights that several pollutants that have been detected exceeding sediment quality guidelines, like As, Cd, Hg, and PAH, are also reported to bioaccumulate and cause damage throughout the trophic levels of the coastal environment. In addition, the potential use of sentinel species and biomarkers for their monitoring is discussed. Finally, the factors that cause pollution and threaten the state of the bay continue to exert pressure and impact; thus, there is a call for the further monitoring of this ecosystem and the strengthening of policies and regulations. © 2023 by the authors.