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

Background and aim: Extracorporeal membrane oxygenation (ECMO) can help children survive severe cardiac and/or respiratory failure, but it is only provided in specialized centers. There are disparities in access by ground transport to ECMO services, but it is unknown to what extent interfacility transfer systems can expand access. Additionally, the number of children who live in proximity to centers that perform extracorporeal cardiopulmonary resuscitation (ECPR) to be potential candidates in case of out-of-hospital cardiac arrest (OHCA) is unknown. We conducted a geospatial analysis to answer these questions. Methods: We conducted a geospatial analysis of the Extracorporeal Life Support Organization (ELSO) database. We defined populations with "indirect access" to ECMO as those who live within a 60-min drive of a hospital within 120 miles of an ECMO center, corresponding to a 1-h one-way transport. We defined "potential access" to ECPR as those living within a 15-min drive of a center that performs ECPR. We examined our results by urbanicity and Child Opportunity Level. Results: While 72.8% of the pediatric population has direct driving access to ECMO services, another 22.5% could have indirect access via interfacility transfer, making overall access nearly universal. Children living in low-opportunity and rural areas are more likely to gain access via interfacility transfer. Only 11.5% of children have potential access to ECPR services. Conclusions: Interfacility transfer has the potential to extend access to ECMO services to nearly all children, and reduce disparities in access. Very few children have timely access to ECPR services in case of OHCA.