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Dysphagia in COVID-19 Patients on Extracorporeal Membrane Oxygenation

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Abstract

Patients on extracorporeal membrane oxygenation (ECMO) are infrequently nourished via oral feeding due to aspiration risks. Patients with COVID-19 and on ECMO represent a subpopulation that has additional factors that may affect their swallow function. This study aimed to describe the swallow function and ability to maintain oral feeding in patients with COVID-19 while on ECMO. A retrospective study of patients with COVID-19 who started veno-venous ECMO at the beginning of the COVID-19 pandemic (March 2020 and August 2020) was conducted at a tertiary care hospital. Clinical swallow evaluations and videofluoroscopic swallow studies (VFSS) were analyzed using standardized measurement scales. Pearson’s correlation coefficient (r) identified relationships between ECMO and swallowing function at different time points. 19 patients were included; all underwent clinical swallow evaluation and 4 underwent VFSS while on ECMO. Mean age was 43.2 years (standard deviation: 9.2), mean duration of ECMO was 65.7 days (58.7), and mean duration of intubation was 14.4 days (8.6). All patients were able to undergo swallow function evaluation, regain swallow function, and resume oral feeding while cannulated. Duration of ECMO and time to feeding tube removal was positively correlated (r = 0.747, p < 0.001) with patients demonstrating less functional swallowing independence and requiring a more modified diet upon oral diet initiation. Clinical swallow evaluation and videofluoroscopic swallowing evaluation are possible for COVID-19 patients actively on ECMO. Patient swallow function can improve, and oral diet can be achieved while on ECMO, demonstrating benefit of SLP surveillance and swallowing assessment prior to ECMO decannulation.

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Data Availability

Data generated and analyzed during this study is available from the corresponding author on reasonable request.

Abbreviations

ECMO:

Extracorporeal membrane oxygenation

ARDS:

Acute respiratory distress syndrome

VFSS:

Videofluoroscopic swallow studies

IDDSI:

International Dysphagia Diet Standardisation Initiative

FOIS:

Functional Oral Intake Scale

MBSImP:

Modified Barium Swallowing Impairment Profile

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Acknowledgements

The authors thank the many healthcare workers for their tireless efforts to serve our patients through the COVID-19 pandemic.

Funding

No funds, grants, or other support were received for this study.

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Authors and Affiliations

  1. Rush Medical College, Rush University, 600 S Paulina St, Suite 403, Chicago, IL, 60612, USA

    Grant S. Owen & Eleni A. Varelas

  2. Department of Otorhinolaryngology – Head and Neck Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite 550 Orthopedic Building, Chicago, IL, 60612, USA

    Grant S. Owen, Michelle E. Mark & Inna A. Husain

  3. Department of Communication Disorders, Rush University, 1611 W Harrison St, Suite 530, Chicago, IL, 60612, USA

    Lisa A. LaGorio

  4. Department of Otolaryngology - Head and Neck Surgery, New York University, New York City, USA

    Eleni A. Varelas

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Contributions

Study conception was by G.S.O., M.E.M., and I.A.H.; design, interpretation of data, revision, approval, and accountability was performed by all authors; data acquisition was performed by G.S.O., L.A.L., M.E.M., and I.A.H.; statistical analysis was performed by G.S.O. and L.A.L.; manuscript drafting was performed by G.S.O., L.A.L., E.A.V., and M.E.M.

Corresponding author

Correspondence to Grant S. Owen.

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Declarations of Interest

The authors have no financial or non-financial interests to disclose.

Research Involving Human Participants

All procedures in this study were conducted in accordance with the Rush University Medical Center Institutional Review Board (No. 2012 − 0103) approved protocols.

Informed Consent

The Rush University Medical Center Institutional Review Board approved a waiver of consent for this study (No. 2012 − 0103) due to this study being declared secondary research due to the information regarding human subjects being de-identified, the subjects were not contacted, and the subjects were not re-identified.

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Owen, G.S., Varelas, E.A., Mark, M.E. et al. Dysphagia in COVID-19 Patients on Extracorporeal Membrane Oxygenation. Dysphagia (2024). https://doi.org/10.1007/s00455-024-10701-6

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