Geospatial Access to Extracorporeal Membrane Oxygenation in the United States.

Summary

Using U.S. Census and GIS data, 67% of the population had ground access to ECMO-capable centers, but entire regions (Puerto Rico, Wyoming, North Dakota, Alaska) lacked access. Limited access correlated with poverty, older age, and low population density, with racial/ethnic disparities in the Midwest and Northeast.

Key Findings

• 67% of the U.S. population had ground access to ECMO-capable centers.
• No access identified in Puerto Rico, Wyoming, North Dakota, and Alaska.
• Limited access correlated with poverty, older age, and lower population density; racial/ethnic disparities were significant in the Midwest and Northeast.

Clinical Implications

Supports regionalization, hub-and-spoke ECMO planning, and consideration of aeromedical transport to mitigate access inequities, particularly in low-density and high-poverty areas.

Limitations

• Cross-sectional design cannot capture temporal changes or outcomes.
• Access defined by ground transport proximity may not reflect real-time availability or capacity.

Future Directions

Model ECMO network scenarios (hub-and-spoke, aeromedical) and evaluate impact on outcomes; incorporate capacity, referral pathways, and real-time transport constraints.