Study highlights disparities in access to advanced life support

Use of extracorporeal membrane oxygenation (ECMO) continues to rise, but this advanced form of life support is often not provided to patients equitably. Now, new research published at the ATS 2025 International Conference has confirmed that disadvantaged patients are less likely to receive ECMO, even though they live closer to hospitals that offer it.

The paper is published in the American Journal of Respiratory and Critical Care Medicine.

The study offers new insights to better understand and address health care disparities, said first author Gwenyth L. Day, MD, research fellow in pulmonary and critical care at the University of Colorado. The findings also raise important questions about why some patients are more likely to end up at hospitals without ECMO capabilities even though they are farther away.

“This study really showed how distance impacts (or doesn’t impact) access to a resource,” she said. “I think we often assume a resource is more accessible if it is within a patient’s local environment, but this study suggests it is much more complicated than that.”

ECMO is a form of advanced life support in which a machine takes over the work of both the heart and lungs, circulating and oxygenating the blood outside the body. It is a high-cost intervention that is not available in all hospitals.

Previous studies had found disparities in patient selection, and researchers wondered if geographical location played a role in why some patients received ECMO and others didn’t.

For the new study, they used a large database to compare patients who received ECMO to those treated with mechanical ventilation only. They also compared hospitals that had ECMO capabilities with those that didn’t and calculated the distance a patient needed to travel to the nearest ECMO hospital.

They found that patients identifying as Black, who have Medicaid, or who live in low-income neighborhoods were less likely to receive ECMO than other patients who were just as sick. Surprisingly, the patients who were least likely to receive ECMO actually lived closer to ECMO-capable hospitals.

Hospitals with ECMO capabilities tended to have more patients with private insurance, as well as patients from higher-income neighborhoods, Dr. Day noted. She said there were several possible reasons why disadvantaged patients might be more likely to be routed to hospitals without ECMO. For example, advertising and outreach might influence where patients choose to go for care.

“It is also possible that bias from providers may impact who gets admitted and who gets transferred out of ECMO-capable hospitals,” Dr. Day said.

The study highlights the need for strong guidelines that mitigate bias in ECMO selection, she said. The findings could also lend support to increased funding for ECMO capabilities in safety net hospitals, she added.

Next, the team is planning a follow-up study to investigate transfer practices as a potential driver for disparities.

Provided by
American Thoracic Society (ATS)