LAUSR

Given the retrospective nature of the study and the complexity of patients, 64% survival is quite a remarkable outcome. Different hybrid configurations have been proposed with questionable effectiveness and feasibility. Veno‐arteriovenous (V‐AV) may probably be a more appropriate configuration in terms of hemodynamic parameters and potential for additional benefit. Nevertheless, full extracorporeal membrane oxygenation (ECMO) support remains detrimental for left ventricular (LV) function due to increased afterload and ventricular volume. The degree of LV unloading depends on the absolute flow and the recruitable contractile reserve of the LV. In my experience, a certain degree of LV ejection is beneficial. After an initial period of stabilization on full ECMO support, partial support may be a more suitable option where the LV continues to eject against a reduced afterload and maintains end‐diastolic volume and end‐systolic volume within limits reducing the potential for ventricular distension. Needless to say, optimization of pump speed, pressure, flow, and PEEP may be required throughout the period of support. Finally, timing is critical and early decision‐making to V‐AV conversion remains the most appropriate course of action as advocated by the authors.