You might already know about it but I saw someone using rtkit with pipewire. I think it’s for real-time threads priorities.
They also changed a bunch of stuff in the default config. I have no idea what it’s for. See: https://github.com/lovesegfault/nix-config/blob/ad9a15936e162e3cb8e28eb5a5d0f2fbd4834ff9/hardware/sound.nix
Just to be clear, I’m not suggesting nixos for audio. Your message just make be think about someone’s config so I thought it could interest people reading this thread.
Note that if you use their version, they host the bridge, so you need to trust them.
Note that medium mode is a good compromise and is a lot less painful than hard mode.