3, 16, 78
Hybrid configurations solve specific physiological mismatches and should be a considered decision, not an escalation reflex; each added limb adds bleeding, infection, thrombosis and haemolysis risk on an anticoagulated patient.
None - descriptive review of case series
DOI 10.21037/jtd.2018.03.84
Hybrid configurations: VAV, VVA, V-Pa, VVVA, VVAV, and LV unloading strategies including surgical vents, transaortic catheters, atrial septostomy, IABP, Impella and Tandem-Heart
Case series and anecdotal reports only. Confounding by indication is total: patients reach a hybrid configuration because a simpler one failed. Reported mortality describes the population, not the intervention. Mortality figures are taken from this review rather than the primary papers.
Taxonomy of hybrid configurations with the specific mismatch each addresses. VAV for differential hypoxaemia on VA or new circulatory failure on VV, with reported mortality of roughly 50-61% across small series; VVA for combined lung and cardiac failure with inadequate single-limb drainage; V-Pa (typically a 17 F cannula into the pulmonary artery) as a percutaneous RVAD that bypasses the RV; VVVA and VVAV anecdotal. Flow splitting between arterial and venous return limbs requires a partial-occlusion clamp and dedicated flow monitoring.
Adults requiring configurations beyond standard VV or VA ECMO