This study examines the use of hybrid extracorporeal life support (ECLS) systems, which incorporate a third cannula for cases where traditional cannulation methods are insufficient. Analyzing data from 28 out of 903 ECLS procedures at the University Hospital Zurich from 2007 to 2019, the research found a 3.1% implementation rate for hybrid ECLS, with a notably high in-hospital mortality rate of 67.9%. Mortality varied significantly across indications such as ARDS, refractory cardiogenic shock, and cardiopulmonary resuscitation. Survivors tended to have lower SAPS II scores and required fewer platelet transfusions, underscoring the importance of careful patient selection for this procedure.