Geospatial Access to Extracorporeal Membrane Oxygenation in the United States

Abstract

OBJECTIVES: To conduct a Geospatial Information System analysis of extracorporeal membrane oxygenation (ECMO) centers in the United States utilizing data from the U.S. Census Bureau to better understand access to ECMO care and identify potential disparities. DESIGN: A cross-sectional descriptive and statistical analysis of geospatial access to ECMO-capable centers in the United States, accounting for demographic variables. SETTING: The unit of analysis were U.S. Census block groups and demographic variables of interest obtained from the American Community Survey. PATIENTS: Patients accounted for in the U.S. Census data. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Sixty-seven percent of the U.S. population had direct access to ECMO-capable centers. Disparities were present, with Puerto Rico, Wyoming, North Dakota, and Alaska having no access. Poverty, increased age, and lower population density consistently correlated with limited access. We identified significant racial and ethnic disparities in the Midwest and Northeast. CONCLUSIONS: While 67% of the U.S. population had access to ECMO-capable centers by ground transportation, significant disparities in access exist. These findings emphasize the need for thoughtful implementation of ECMO systems of care to ensure equitable access. Future work should focus on developing novel systems of care that increase access utilizing advanced technology, such as aeromedical transport services.