The Safety and Utility of Early Swallow Assessment Using Flexible Endoscopic Evaluation of Swallowing (FEES) in Patients Requiring Extra Corporeal Membrane Oxygenation (ECMO): A Case Series (Four Reports)

A significant proportion of patients requiring Extra Corporeal Membrane Oxygenation (ECMO) are now considered safe for earlier tracheostomy insertion, allowing for sedation wean and commencement of rehabilitation. Speech and Language Therapy (SLT) clinical swallow assessment usually occurs following tracheostomy cuff deflation, when signs of dysphagia and aspiration are detectable. Cuff deflation can be difficult to establish in patients on ECMO with complex ventilation requirements, with prolonged cuff inflation delaying oral feeding. Flexible Endoscopic Evaluation of Swallowing (FEES) is used routinely in critical care, but application in the ECMO cohort is a new development. FEES offers the potential for earlier accurate swallowing assessment irrespective of cuff status. Safety, utility and outcomes of FEES in cardiothoracic patients with tracheostomies requiring ECMO has not previously been reported. This case series demonstrates the outcomes and benefits of FEES for expediting earlier, safe oral intake in this population.