Patients from low-income neighborhoods, those with Medicaid, and Black patients were less likely to receive ECMO than equally ill peers.
RT’s Three Key Takeaways:
- Disadvantaged patients are less likely to receive ECMO—even when nearby: Patients from low-income neighborhoods, those with Medicaid, and Black patients were less likely to receive ECMO than equally ill peers, despite living closer to ECMO-capable hospitals.
- Hospital access doesn’t equal hospital admission: The findings suggest that proximity to specialized care doesn’t guarantee access. Factors like hospital selection, referral patterns, and potential provider bias may influence who receives advanced treatments like ECMO.
- Study underscores need for equity-focused policies: The research points to the importance of developing standardized, bias-resistant ECMO selection criteria and expanding access to ECMO in safety net hospitals serving vulnerable populations.
Disadvantaged patients are less likely to receive ECMO, even though they live closer to hospitals that offer it, according to research published at ATS 2025.
The study offers new insights to better understand and address healthcare 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 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.
