Research Uncovers Inequities in Access to Advanced Life Support Systems

Recent research has shed light on the inequitable access to extracorporeal membrane oxygenation (ECMO), a vital advanced life support system. Despite an increase in the use of ECMO, the study reveals that patients from disadvantaged backgrounds are less likely to receive this critical intervention, even when they reside close to hospitals equipped with ECMO capabilities.

Published in the American Journal of Respiratory and Critical Care Medicine, the study was presented at the ATS 2025 International Conference. It aims to enhance understanding of healthcare disparities, as articulated by the study's lead researcher, who noted the unexpected geographical factors influencing patient access to ECMO.

ECMO is a life-saving technology that temporarily takes over the functions of the heart and lungs, allowing for blood oxygenation and circulation outside the body. However, it is not universally available, and its high cost further complicates access.

The study utilized a comprehensive database to examine the profiles of patients who received ECMO compared to those who were treated solely with mechanical ventilation. Researchers analyzed the locations of hospitals offering ECMO services and the distances patients had to travel to access these facilities.

Findings indicated a troubling trend: patients who identified as Black, were enrolled in Medicaid, or lived in low-income neighborhoods had a significantly lower likelihood of receiving ECMO, despite the severity of their medical conditions. In a surprising twist, many of those least likely to receive ECMO lived closer to hospitals that provided this service.

Moreover, hospitals that offered ECMO tended to cater to a patient demographic with higher rates of private insurance and residents from wealthier neighborhoods. The researchers suggest that various factors might contribute to the routing of disadvantaged patients to hospitals lacking ECMO capabilities. These include the potential influence of hospital marketing and community outreach efforts, as well as possible biases from healthcare providers regarding patient admissions.

The implications of this study underscore the necessity for robust guidelines that can help eliminate biases in ECMO patient selection. Additionally, there is a call for increased funding and resources to expand ECMO capabilities within safety net hospitals, which predominantly serve low-income populations.

Looking ahead, the research team is planning follow-up studies to further explore transfer practices and how they might contribute to the observed disparities in access to advanced life support.