Penetrating thoracic injuries have high risks of morbidity and mortality, with severe pulmonary vascular and bronchial injuries sometimes necessitating post-traumatic pneumonectomy and perioperative ECMO support due to right ventricular and respiratory failure. This case describes a male with a penetrating thoracic injury presenting with a massive right hemothorax and active bleeding, requiring ligation of the right pulmonary hilum. He subsequently developed right ventricular dysfunction and ARDS, necessitating a dynamic hybrid ECMO configuration to support his recovery. This case highlights that ECMO support can reduce mortality and complications in such severe injuries. Effective management requires a multidisciplinary team for optimal outcomes in severely compromised patients.