This geospatial cross-sectional study examined how access to pediatric extracorporeal membrane oxygenation varies across U.S. states and Pediatric Emergency Referral Regions. Researchers identified 258 pediatric ECMO centers and 169 ECPR centers, finding major differences in direct access, especially in rural areas. Although interfacility transport made ECMO access nearly universal in many places, access to ECPR remained very limited for most children.