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. 2025 Apr 1;53(4):e874-e883.
doi: 10.1097/CCM.0000000000006607. Epub 2025 Feb 17.

Geospatial Access to Extracorporeal Membrane Oxygenation in the United States

Adam L Gottula  1   2   3 , Hannah Van Wyk  4 , Man Qi  5 , Melissa A Vogelsong  6 , Chris R Shaw  7 , Joseph E Tonna  8 , Nicholas J Johnson  9   10 , Anna Condella  9   10 , Jason A Bartos  3   11 , Veronica J Berrocal  12 , Justin L Benoit  13 , Cindy H Hsu  1   2   14
Affiliations

Geospatial Access to Extracorporeal Membrane Oxygenation in the United States

Adam L Gottula et al. Crit Care Med. .

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.

Keywords: access to care; equity; extracorporeal membrane oxygenation; geospatial modeling.

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Conflict of interest statement

Dr. Tonna’s institution received funding from the National Heart, Lung, and Blood Institute; he disclosed that he is Chair of the Registry Committee of the Extracorporeal Life Support Organization; he received support for article research from the National Institutes of Health (NIH); and he disclosed off-label use of extracorporeal membrane oxygenation for greater than 6 hours. Drs. Johnson’s and Hsu’s institutions received funding from the NIH. Dr. Johnson’s institution received funding from the Centers for Disease Control and Prevention and the American Heart Association. Dr. Hsu’s institution received funding from the Chang Gung Medical Foundation and the Tzu Chi Medical Foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Fifteen-, 30-, and 45-min drivetime shapefiles were overlaid onto census block group population-weighted centroids to determine geospatial access to an extracorporeal membrane oxygenation (ECMO)-capable center on the block group-level. This figure shows a zoomed-in example of the greater Seattle-Tacoma area in Washington state.
Figure 2.
Figure 2.
Extracorporeal membrane oxygenation (ECMO)-capable center drivetime polygons overlaid onto U.S. population density map by county.
See this image and copyright information in PMC

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References

    1. Peek GJ, Mugford M, Tiruvoipati R, et al. ; CESAR trial collaboration: Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): A multicentre randomised controlled trial. Lancet. 2009; 374:1351–1363 - PubMed
    1. Combes A, Schmidt M, Hodgson CL, et al. : Extracorporeal life support for adults with acute respiratory distress syndrome. Intensive Care Med. 2020; 46:2464–2476 - PMC - PubMed
    1. Yannopoulos D, Bartos J, Raveendran G, et al. : Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): A phase 2, single centre, open-label, randomised controlled trial. Lancet. 2020; 396:1807–1816 - PMC - PubMed
    1. Belohlavek J, Yannopoulos D, Smalcova J, et al. : Intraarrest transport, extracorporeal cardiopulmonary resuscitation, and early invasive management in refractory out-of-hospital cardiac arrest: An individual patient data pooled analysis of two randomised trials. EClinicalMedicine. 2023; 59:101988. - PMC - PubMed
    1. Papazian L, Aubron C, Brochard L, et al. : Formal guidelines: Management of acute respiratory distress syndrome. Ann Intensive Care. 2019; 9:69. - PMC - PubMed