Access to pediatric extracorporeal membrane oxygenation: a geospatial analysis of the racial/ethnic composition of areas with and without access.

Abstract

Background: We propose that all communities should have access to lifesaving technologies like pediatric extracorporeal membrane oxygenation (ECMO), and that distance is one actionable component to accessibility. We chose to examine whether geographic access by distance to pediatric ECMO differs by race/ethnicity for populations historically excluded from health services and technologies.

Methods: Population data was obtained from the US Census Bureau's American Community Survey. Pediatric ECMO program data was obtained from the Extracorporeal Life Support Organization Registry. We compared the proportion of individuals that are American Indian/Alaska Native, Black/African American, Hispanic/Latina(o), or White that live within and outside of a 200-mile distance from pediatric ECMO programs.

Results: 43% of the total US land area falls outside of the US catchment area for pediatric ECMO; and 4.91% of the US population (or 16,433,563 persons) does not have access to a Pediatric ECMO center. One of every four individuals that identify as American Indian/Native American, one of every 100 who identify as Black/African American, one of every 12 that identify as Hispanic/Latina(o), and one of every 21 that identify as White live outside of the pediatric ECMO catchment area for the United States.

Conclusions: American Indian/Native Americans and Hispanic/Latina(o)s lack access to pediatric ECMO by proximity. While Black/African Americans live close to ECMO programs, previous studies show that this population has less access to primary and specialized care. Distance is one actionable measurement that should be used to extend access to medical technologies for populations that have historically been excluded.