Location
Moultrie, GA
Start Date
17-4-2026 12:00 PM
End Date
17-4-2026 1:00 PM
Description
Introduction: Extracorporeal membrane oxygenation (ECMO) is a potentially lifesaving intervention for patients in refractory cardiac or respiratory failure, but getting patients to an ECMO-capable center quickly is as important as the technology itself. While prior national analyses have demonstrated geospatial disparities in ECMO access broadly, regional heterogeneity within the Southeastern United States remains incompletely characterized at the county level. This region is home to large rural populations distributed across health systems of markedly varying capacity, raising important questions about who can realistically reach an ECMO-capable center in time. We set out to map and quantify those gaps across six Southeastern states.
Methods: We conducted a spatial analysis using publicly available county boundary data and ECMO center locations from the Extracorporeal Life Support Organization (ELSO) registry across Alabama, Florida, Georgia, North Carolina, South Carolina, and Tennessee. Straight-line distances from each county centroid to the nearest ECMO-capable hospital were calculated using QGIS. Counties were then grouped by access tier: good (≤30 miles), moderate (30–60 miles), or limited (>60 miles). We summarized findings at the state level using median distance, interquartile range (IQR), and the proportion of counties in the limited-access category.
Results: Across all 534 counties analyzed, geographic access to ECMO varied substantially by state. Alabama demonstrated the greatest access burden by a wide margin, with a median county distance of 74.65 miles (IQR 52.03–96.09) and nearly two-thirds of its counties (65.7%) more than 60 miles from the nearest ECMO center. North Carolina fared best overall, with a median distance of 37.57 miles (IQR 23.99 -- 51.71) and only 15.0% of counties classified as having limited access, closely followed by South Carolina at 13.0%. Georgia and Tennessee fell in the middle of the pack, each with roughly one-third of counties beyond the 60-mile threshold (33.9% and 32.6%, respectively). Florida, while performing better than Alabama on median distance (39.74 miles, IQR 22.09 -- 67.54), still had nearly 30% of counties in the limited-access category, illustrating that statewide averages can mask meaningful pockets of geographic isolation.
Conclusion: Significant geographic disparities in ECMO access exist across the Southeastern United States, with Alabama bearing a disproportionate share of the burden. Several limitations of this analysis warrant acknowledgment. ECMO center locations were derived solely from the ELSO registry without independent verification of operational capabilities, and the registry does not consistently distinguish between pediatric-only and adult-capable programs. At least two centers included in this analysis were designated as having limited ECMO capacity at the time of data collection. Additionally, straight-line distance does not account for road infrastructure, transport times, or regional systems of care. Taken together, these factors suggest our findings likely represent a conservative estimate of true access barriers. These results underscore the need for regionalized referral networks, optimized interfacility transport, and more deliberate placement of advanced cardiac critical care resources across the region. Whether the counties most geographically isolated from ECMO care are also those facing the greatest sociodemographic disadvantage remains a question that warrants further investigation.
Embargo Period
5-28-2026
Included in
Geographic Disparities in County-Level Access to ECMO Centers Across the Southeastern United States
Moultrie, GA
Introduction: Extracorporeal membrane oxygenation (ECMO) is a potentially lifesaving intervention for patients in refractory cardiac or respiratory failure, but getting patients to an ECMO-capable center quickly is as important as the technology itself. While prior national analyses have demonstrated geospatial disparities in ECMO access broadly, regional heterogeneity within the Southeastern United States remains incompletely characterized at the county level. This region is home to large rural populations distributed across health systems of markedly varying capacity, raising important questions about who can realistically reach an ECMO-capable center in time. We set out to map and quantify those gaps across six Southeastern states.
Methods: We conducted a spatial analysis using publicly available county boundary data and ECMO center locations from the Extracorporeal Life Support Organization (ELSO) registry across Alabama, Florida, Georgia, North Carolina, South Carolina, and Tennessee. Straight-line distances from each county centroid to the nearest ECMO-capable hospital were calculated using QGIS. Counties were then grouped by access tier: good (≤30 miles), moderate (30–60 miles), or limited (>60 miles). We summarized findings at the state level using median distance, interquartile range (IQR), and the proportion of counties in the limited-access category.
Results: Across all 534 counties analyzed, geographic access to ECMO varied substantially by state. Alabama demonstrated the greatest access burden by a wide margin, with a median county distance of 74.65 miles (IQR 52.03–96.09) and nearly two-thirds of its counties (65.7%) more than 60 miles from the nearest ECMO center. North Carolina fared best overall, with a median distance of 37.57 miles (IQR 23.99 -- 51.71) and only 15.0% of counties classified as having limited access, closely followed by South Carolina at 13.0%. Georgia and Tennessee fell in the middle of the pack, each with roughly one-third of counties beyond the 60-mile threshold (33.9% and 32.6%, respectively). Florida, while performing better than Alabama on median distance (39.74 miles, IQR 22.09 -- 67.54), still had nearly 30% of counties in the limited-access category, illustrating that statewide averages can mask meaningful pockets of geographic isolation.
Conclusion: Significant geographic disparities in ECMO access exist across the Southeastern United States, with Alabama bearing a disproportionate share of the burden. Several limitations of this analysis warrant acknowledgment. ECMO center locations were derived solely from the ELSO registry without independent verification of operational capabilities, and the registry does not consistently distinguish between pediatric-only and adult-capable programs. At least two centers included in this analysis were designated as having limited ECMO capacity at the time of data collection. Additionally, straight-line distance does not account for road infrastructure, transport times, or regional systems of care. Taken together, these factors suggest our findings likely represent a conservative estimate of true access barriers. These results underscore the need for regionalized referral networks, optimized interfacility transport, and more deliberate placement of advanced cardiac critical care resources across the region. Whether the counties most geographically isolated from ECMO care are also those facing the greatest sociodemographic disadvantage remains a question that warrants further investigation.