Extracorporeal membrane oxygenation (ECMO) is a rapidly growing resource for the most critically ill patients with respiratory and/or circulatory failure. [1,2] ECMO is one of the most resource intensive interventions in health care and, as such, not all hospitals have ECMO capabilities. During the COVID-19 pandemic, the lack of access to ECMO was associated with an increased the risk of death for many patients. [3,4] Unfortunately, use of ECMO is not equitable. Patients identifying as Female or Black, those with Medicaid, and those living in lower-income neighborhoods are all less likely to receive treatment with ECMO than their comparator groups for unclear reasons. [5,6]

It is unclear what is driving patient-selection disparities for ECMO. However, given the high cost and resource intensive nature of ECMO, it is possible that certain vulnerable populations may have less access to ECMO-capable hospitals. In healthcare, distance needed to travel has been shown to be a barrier to access for many conditions including ICU admission. [[7], [8], [9]] While existing data suggests that most adults have limited access to ECMO-capable centers, this older data did not account for actual ECMO use or the rapid expansion of ECMO-capable hospitals in recent years. [10] There is a dearth of data on how ECMO-capable and non-ECMO-capable hospitals may differ in terms of the patients they serve and the distance that patients need to travel to the nearest ECMO-capable hospital. Using actual ECMO admission records, we conducted a retrospective study evaluating differences in hospital characteristics at ECMO and non-ECMO hospitals as well as the distance needed to travel to the nearest ECMO-capable hospital in order to investigate access as a potential driver for disparities.