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IntroductionExtracorporeal membrane oxygenation (ECMO) provides lifesaving support for severe respiratory and cardiac failure. Hybrid modes such as venoarteriopulmonary (VAP) may be necessary when conventional modes fail to meet complex physiological demands.Case ReportA 31-year-old woman with dermatomyositis-associated interstitial lung disease developed severe respiratory failure. She was initiated on venovenous (VV) ECMO, later complicated by right ventricular injury (RVI) requiring conversion to venopulmonary (VP) ECMO, and ultimately required hybrid VAP ECMO for progressive RVI and cardiogenic shock while awaiting heart-lung transplantation. The unique cannulation configuration provided additional cardiorespiratory support and hemodynamic stabilization, which later enabled safe transfer for transplantation.DiscussionHybrid VAP ECMO may provide effective rescue support for patients with refractory RVI and respiratory failure despite VP ECMO, preserve a surgically naïve chest, avoid differential oxygenation, and serve as a bridge to combined heart-lung transplant.ConclusionHybrid VAP ECMO represents an effective salvage strategy and bridge-to-transplant in complex cardiopulmonary failure.