Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*
Authors' conclusion
Associations between ECMO utilization and outcomes with SDoH are inconsistent, complicated by population heterogeneity and analytic shortcomings with limited consideration of systemic contributors.
Study context
- Population
- Extracorporeal membrane oxygenation (ECMO) patients; studies of social determinants of health (SDoH) (socioeconomic status (SES), race, ethnicity, hospital and ECMO program characteristics, transport, geographic location) and ECMO utilization or outcomes, January 2000 to January 2023studies identified
- Participants
- 219 patients
- Outcome
- Direction of associations of race, ethnicity, SES or payer variables with ECMO outcomes or utilization
Methodological detailsPRISMA scoping review extension, risk of bias assessed with Quality in Prognosis Studies tool
- PRISMA scoping review extension
- Risk of bias assessed with Quality in Prognosis Studies tool
Main finding
As reported in the abstract
Direction of associations by race, ethnicity, SES or payer (148 studies)
- Studies including race/ethnicity/SES/payer variables (primary analysis)
- 148 (68%)
- Investigating ECMO outcomes
- 114 (77%)
- Investigating ECMO utilization
- 43 (29%)
- SDoH the primary predictor
- 15 (10%)
- Advanced statistics used; overall quality and methodologic rigor poor
- 7%
- Adverse outcomes or lower use in underrepresented, under-resourced or diverse populations
- 38%
- Improved outcomes or greater use in these populations
- 7%
- No statistically significant result
- 55%
- Discussed mechanistic drivers of disparities, mainly individual- and hospital-level rather than systemic/structural
- 26 studies (18%)
Original publication
Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*. Crit Care Med. Published 28 March 2023. doi:10.
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