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Geographic access to pediatric ECMO and ECPR: a geospatial study of transport networks and disparities

Allan M Joseph1,2,3, Andrew J Lautz1,2, Carlie N Myers1,2,3

  • 1Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.

Resuscitation Plus
|February 2, 2026
PubMed

Insights

Interfacility transfer can provide nearly universal access to pediatric extracorporeal membrane oxygenation (ECMO) services, reducing disparities. However, timely access to extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest remains limited for most children.

Area of Science:

  • Pediatric critical care medicine
  • Geospatial health analysis
  • Healthcare access and equity

Background:

  • Extracorporeal membrane oxygenation (ECMO) is vital for pediatric survival in severe cardiac/respiratory failure but is limited to specialized centers.
  • Existing ground transport access to ECMO services shows disparities; the role of interfacility transfer systems in expanding access is unclear.
  • The proximity of children to extracorporeal cardiopulmonary resuscitation (ECPR) centers for out-of-hospital cardiac arrest (OHCA) is unknown.

Purpose of the Study:

  • To assess the geospatial extent of access to pediatric ECMO services.
  • To evaluate the potential of interfacility transfer systems to broaden ECMO access.
  • To determine the number of children with potential access to ECPR for OHCA.

Main Methods:

  • Geospatial analysis of the Extracorporeal Life Support Organization (ELSO) database.
  • Defined "indirect access" to ECMO as living within a 60-min drive of a hospital within 120 miles of an ECMO center.
  • Defined "potential access" to ECPR as living within a 15-min drive of an ECPR-performing center, analyzing by urbanicity and Child Opportunity Level.

Main Results:

  • 72.8% of children have direct driving access to ECMO; an additional 22.5% have indirect access via interfacility transfer, nearing universal access.
  • Interfacility transfer disproportionately benefits children in low-opportunity and rural areas.
  • Only 11.5% of the pediatric population has potential access to ECPR services.

Conclusions:

  • Interfacility transfer significantly enhances access to pediatric ECMO, potentially mitigating existing disparities.
  • Current access to ECPR services for pediatric OHCA is critically limited, highlighting a gap in timely emergency care.
  • Geospatial analysis is crucial for understanding and addressing healthcare access inequities in specialized pediatric interventions.
Abstract

Keywords:
AccessDisparitiesExtracorporeal cardiopulmonary resuscitationExtracorporeal membrane oxygenationHelicopter transportInterfacility transfer

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