Article Impact Level: HIGH Data Quality: STRONG Summary of American Journal of Respiratory and Critical Care Medicine, 211(Abstracts), A7365–A7365. https://doi.org/10.1164/ajrccm.2025.211.Abstracts.A7365 Dr. G.L. Day et al.
Points
- This study found that Black patients, Medicaid recipients, and those from low-income neighborhoods had significantly lower odds of receiving ECMO compared to White patients or those with private insurance.
- Only 20 percent of safety-net hospitals had ECMO capabilities, highlighting structural disparities in hospital resources available to underserved populations.
- Disadvantaged patients often lived closer to ECMO-capable hospitals but were still less likely to receive ECMO, suggesting that proximity does not equate to access.
- The disparities in ECMO use were strongly influenced by hospital type and patient insurance status, not just geographic location.
- The authors call for targeted policies and funding to expand ECMO availability in safety-net hospitals and ensure equitable access to critical care across all patient populations.
Summary
This study investigated disparities in selecting patients for extracorporeal membrane oxygenation (ECMO), focusing on the role of access to ECMO-capable hospitals. A retrospective cohort study utilizing 2020 State Inpatient Databases from seven states in the U.S. analyzed 3,571 ECMO cases across 235 hospitals. The study found significant disparities based on patient demographics and hospital type. For example, patients identifying as Black had adjusted odds of receiving ECMO of 0.69 (95% CI 0.60–0.78) compared to White patients, while those with Medicaid had aOR = 0.68 (95% CI 0.61–0.75) compared to private insurance. Additionally, patients from low-income neighborhoods had lower odds of receiving ECMO (aOR = 0.70, 95% CI 0.62–0.80).
The study also highlighted that hospitals with a high percentage of patients with Medicaid or low-income backgrounds were less likely to have ECMO capabilities. Only 20% of safety-net hospitals (SNHs) had ECMO capabilities, compared to 32% of non-SNHs. Despite living closer to ECMO-capable hospitals, patients from disadvantaged groups were less likely to receive ECMO, with Black patients and those on Medicaid having shorter travel distances but lower access to ECMO. The median distance for Black patients to ECMO hospitals was 12.0 miles, compared to 18.8 miles for White patients.
These findings point to access to ECMO-capable hospitals as a significant driver of disparities in patient selection for ECMO. The study emphasizes the need for policies and funding to increase ECMO capabilities at SNHs and reduce barriers for disadvantaged patients. Addressing these disparities could improve equitable access to life-saving treatments, such as ECMO, and reduce the mortality gap between different socioeconomic groups.
Link to the article: https://www.atsjournals.org/doi/10.1164/ajrccm.2025.211.Abstracts.A7365
References Day, G. L., Douglas, I. S., Barocas, J. A., & Mehta, A. B. (2025). Access as a driver of disparities in patient selection for extracorporeal membrane oxygenation. American Journal of Respiratory and Critical Care Medicine, 211(Abstracts), A7365–A7365. https://doi.org/10.1164/ajrccm.2025.211.Abstracts.A7365
