Voice and Swallowing Dysfunction Associated With Extracorporeal Membrane Oxygenation in Pediatric Patients.

OBJECTIVES

This study aims to determine the incidence of vocal fold motion impairment (VFMI) and swallowing dysfunction in pediatric patients undergoing cervical extracorporeal membrane oxygenation (ECMO) and the role of screening for compromise.

METHODS

A retrospective cohort analysis of voice, swallowing, and respiratory difficulty was performed among pediatric patients undergoing cervical ECMO cannulation and decannulation from 2012 to 2019. Data collected included weight, age, length of hospital stay, duration of intubation, ECMO procedure details, feeding interventions, and swallowing and airway evaluations.

RESULTS

This study included 77 patients with a median age of 3 days. Right vocal cord hypomobility or immobility was identified in 23 % of patients (n = 18), and 26 % (n = 20) had swallowing dysfunction. Twelve (15.6 %) patients had concurrent VFMI and swallowing dysfunction following decannulation. Median weight at cannulation was significantly lower in patients with VFMI (3.15 kg) than those without (3.93 kg). No significant differences were detected when comparing age, gestational age, type and location of ECMO procedure, and intubation duration/attempts. Despite concern for dysphonia in 42 patients, only 26 underwent flexible fiberoptic laryngoscopy.

CONCLUSION

VFMI and swallowing dysfunction are common in pediatric ECMO patients. This study is the first to document a clinically significant risk of vocal and swallowing dysfunction in children requiring ECMO. The study may underestimate the incidence of VFMI and swallowing dysfunction in these patients. In the future, we aim to prospectively evaluate patients after successful ECMO decannulation and extubation to identify VFMI and dysphagia promptly and provide appropriate follow-up and intervention for patients with persistent or prolonged respiratory and feeding difficulty.