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Voice and Swallowing Dysfunction Associated With Extracorporeal Membrane Oxygenation in Pediatric Patients
Ezer H Benaim1, Elizabeth N Ritter1, Kelly D Kamp2
1Department of Otolaryngology - Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Insights
Vocal fold motion impairment (VFMI) and swallowing dysfunction are common in pediatric patients after cervical extracorporeal membrane oxygenation (ECMO). Early screening is crucial for timely intervention in these high-risk children.
Area of Science:
- Pediatric critical care medicine
- Otolaryngology
- Speech-language pathology
Background:
- Cervical extracorporeal membrane oxygenation (ECMO) is a life-saving intervention for critically ill neonates and children.
- Potential complications include vocal fold motion impairment (VFMI) and swallowing dysfunction, impacting long-term outcomes.
- Limited data exists on the incidence and interplay of these dysfunctions following pediatric cervical ECMO.
Purpose of the Study:
- To determine the incidence of VFMI and swallowing dysfunction in pediatric patients undergoing cervical ECMO.
- To investigate the role of screening in identifying these complications.
- To highlight the clinical significance of vocal and swallowing issues in this population.
Main Methods:
- Retrospective cohort analysis of pediatric patients (2012-2019) who underwent cervical ECMO.
- Data collection included patient demographics, ECMO details, intubation duration, and feeding interventions.
- Voice, swallowing, and airway evaluations were reviewed.
Main Results:
- 77 pediatric patients were included; 23% had VFMI and 26% had swallowing dysfunction.
- 15.6% experienced concurrent VFMI and swallowing dysfunction post-decannulation.
- Lower weight at cannulation was associated with VFMI; screening was underutilized despite concerns.
Conclusions:
- VFMI and swallowing dysfunction are prevalent complications in pediatric cervical ECMO survivors.
- This study underscores a significant risk, potentially underestimating true incidence.
- Prospective evaluation is needed for prompt identification and intervention.
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.
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