1249: Geographic Accessibility of Pediatric Ecmo Services

Introduction: Pediatric acute care services are increasingly centralized in fewer hospitals. No prior studies have examined geographic access to pediatric ECMO services considering transport modalities, real-world driving time, or rapid transfer systems. We hypothesize that few US children have immediate driving access to ECMO services, but most have access via rapid air transfer. Methods: We analyzed geospatial data to assess pediatric ECMO access using public data from ELSO reporting centers with at least one pediatric or neonatal ECMO run in the last five years. We linked ECMO centers to census tract data and used ArcGIS Pro to measure the proportion of children with direct access to these centers within 15-, 30-, 45-, and 60-minutes’ drive, and indirect access. Indirect access is defined as residing within a 60-minute drive of a potential referral hospital within 120 miles of an ECMO center, which corresponds to a 1-hour one-way rotor-wing transport. We analyzed access to neonatal ECMO services for infants under one. We also examined variation in access by state. Results: We identified 258 centers reporting pediatric ECMO services. Only 14.6% of the 73 million US children under 15 could drive to an ECMO center within 15 minutes, increasing to 45.8% within 30 minutes, 62.8% within 45 minutes, and 72.8% within 60 minutes. However, 95.3% of US children had indirect access to ECMO services via air transfer. Of infants, 12.1% had access to a neonatal ECMO center within 15 minutes, increasing to 68.8% within 60 minutes and 93.4% via indirect access. Access to ECMO centers varies by state; in 15 states, over half of children cannot reach a center within 60 minutes and in 5 states, most children lack indirect access. Conclusions: Pediatric ECMO services show moderate geographic accessibility by direct driving time, with significant differences among states. However, most US children can access ECMO services via air transfer, emphasizing the importance of strong interfacility transport systems that enable children with time-sensitive conditions to reach specialized centers. Additionally, there is a critical need to develop and expand rapid transfer programs for those areas still lacking both direct and indirect access to these essential services.