Some 30 staff members from Loma Linda University Medical Center and Children’s Hospital crowded together in an ICU room on December 30, 2021, to help save the lives of a pregnant mother critically ill with COVID-19 and her twin micro-preemie babies.
Two weeks before the emergency operation earlier, May’s teenage daughter had returned home complaining of a headache. May suspected she might have contracted COVID-19, and a positive test confirmed that she and two of her children were sick. May was also 22-weeks pregnant with twins.
Her kids quickly improved, but she did not. “They were bouncing off the walls again after two days, never really sick, but with me, it just kept getting worse day-by-day,” May says.
May went to a hospital where she lives in Victorville. Staff there X-rayed her lungs and told her she was fine, to return home, and just let it play out. “That kind of upset me because I was pregnant, and they were turning me away — I knew everything wasn’t okay,” she says.
Her symptoms only worsened with headaches, intense coughing, chest pain, loss of taste and smell, and vomiting. She kept trying to eat, knowing her unborn babies needed nutrition, but nothing stayed down. “I was so sick,” May says. “I was weak and just sleeping the time away.”
She doesn’t remember much after that.
Reza Salabat, MD, a cardiothoracic surgeon at Loma Linda University Medical Center, became one of May’s doctors upon her transfer to the Medical Center on December 20. Within days, she was in critical condition. Her oxygen levels were extremely low, and her CO2 levels were very high. She was intubated, heavily sedated, and paralyzed. The use of medicine to dilate her pulmonary vasculature, allowing for better gas exchange and oxygenation, was not working. Positioning her differently to improve oxygen flow was not working. “None of our efforts were helping her improve,” Salabat recalls.
May needed to be placed on ECMO — extracorporeal membrane oxygenation — a device that takes over the function of a person’s lungs, oxygenating the blood in the body, and is most often used when other medical options have been exhausted. But this was no easy decision or small task. Salabat says he’d never previously heard of putting a pregnant person on ECMO so early in a pregnancy.
“I’ve had pregnant patients that I’ve put on ECMO due to COVID, but they were usually right around the gestational age where a C-section could be performed to deliver the baby,” Salabat says. “These babies were too immature. And there was not only one but two.”
Ruofan Yao, MD, an OBGYN and maternal-fetal medicine specialist at Children’s Hospital, says that placing a pregnant mother on ECMO was not a common or needed practice until the pandemic, making it a relatively new technology to apply to pregnancy.
“Chaquan was entering into what we call the viable period, which is a really difficult period of time for decision-making,” Yao says. “The babies are almost viable somewhere between 23 to 24 weeks, but when is the cutoff while the mother is so critical?”
Yao, Salabat, and other colleagues discussed the impossible decision of where to focus the bulk of their efforts — on May or on her twins. They agreed the babies were too small — it was just too early, with the chances of 22-week-old babies surviving after delivery being nearly non-existent. The team decided to proceed with all possible lifesaving measures for May.
An incredible team effort, a miraculous but bittersweet outcome
ECMO bought May time, but her oxygen levels were still not stable.
When the babies were approximately 24 weeks gestation, Yao, Salabat, and the team regrouped to discuss the situation and everyone’s concerns. The babies qualified as “extremely premature” being under 28 weeks gestation. With their micro-premie status, May’s twins only had approximately 60-70% chance of survival.
However, it was agreed that May needed to be delivered — her organs were going downhill with no positive end in sight.
On December 30, right in May’s ICU room, her twin girls were delivered via C-section, surrounded and saved by the efforts of many dedicated, multi-disciplinary teams — nurses, techs, labor and delivery, NICU, the cardiothoracic and ECMO teams, social work, attending fellows, residents, and more.
The team had made the right decision. May began improving over the course of the next month. Her mental status improved, oxygen levels improved, and she was finally able to breathe again on her own.
“It’s amazing,” Salabat says. “I didn’t have much hope, but this was a miracle. All of our teams — the ICU staff, OB staff, and especially all the nurses played such a major role in this success story. They did all of the hardest work to save our patients.”
In total, May was on ECMO for 38 days — finally getting off the machine on February 2, 2022. She is home and doing well.
May’s twins, while another story of amazing survival, is bittersweet. Gi’anni Miracle and Gi’arri Blessing were born at approximately one pound each with translucent skin — so small one could hold them in their palm. After facing seemingly insurmountable odds and filling May’s life with miracles, precious Gi’anni succumbed to health issues and passed away in April.
“We know we are blessed, but it has been hard and so bittersweet,” May says. “When we go to the NICU to see Gi’arri, we can’t help but think of Gi’anni.”
May says doctors are hoping Gi’arri will soon be discharged from the NICU by the end of May, ready to live and grow outside the hospital.
While she and her family are still healing emotionally and physically, May says she wouldn’t have made it without everyone who cared for her, treating her with compassion and with love.
“I want to thank everybody who helped me along the way,” May says. “I’m so thankful to be alive. I wish I knew the names of every single person who cared for me because I won’t ever forget them or this experience.”
Salabat says he feels immense pride to work with such talented and dedicated people. Yao echoes that sentiment.
“Perhaps the most impressive thing about all of this is that it wasn’t any individual person or one team that made all of these decisions,” Yao says. “It’s that we came together to have this educated discussion from such a diverse multi-disciplinary standpoint about how to care for a very, very sick mom who was carrying very sick and small babies. We mobilized all our recourses and cared for them to the best of our ability.”