A few days after Thanksgiving, Dallas Selling — 19-weeks pregnant with twins — started feeling sick with a fever and had difficulty breathing. For days she tried to “tough” it out, but she finally gave in on Dec. 2 and called an ambulance. She was taken to Clovis Community Medical Center’s emergency department.
“Obviously no one wants to go to the hospital, but you have to listen to your body,” Selling said. “I’ve always been the type to push myself really hard … but you know when something is wrong.”
Because of her coronavirus infection, Selling’s lungs just weren’t able to take in enough oxygen for her and the babies, so the next day she was transferred to Community Regional Medical Center for a higher level of care. The team from the Valley’s only high risk antepartum center was standing by to help the intensive care team.
Pregnant women more at risk with coronavirus
At Community Regional, Selling was put on a ventilator when her oxygen levels continued to drop. For almost three weeks she continued to decline. Fearing the worst, her physicians and husband decided she needed extracorporeal membrane oxygenation (ECMO) treatment in order to save her and the babies.
Recently released information from the U.S. Centers for Disease Control and Prevention (CDC) shows that pregnant women are at higher risk for complications from COVID-19 infection. The CDC says COVID-19-positive pregnant women who are symptomatic are two to four times more likely than non-pregnant women of similar age to develop severe illness. These women are more likely to require ICU admission, ECMO treatment or mechanical ventilation, and have a 70% higher risk of death than non-pregnant women.
Care team says ECMO treatment necessary
“We did ECMO because we were unable to provide enough oxygen to her blood and remove enough carbon dioxide without causing further damage to her lungs with the ventilator,” said Community Regional emergency medicine physician Crystal Ives-Tallman. “It’s really just a bridge so we can protect her lungs and allow them to recover.”
ECMO pumps and oxygenates a patient's blood outside the body, allowing the heart and lungs to rest, according to Dr. Ives-Tallman, who’s an assistant professor at UCSF Fresno. The blood flows through tubing to an artificial lung in the machine that adds oxygen and takes out carbon dioxide; it’s then warmed to body temperature and pumped back into the body.
One place in Valley with ECMO expertise, team
Community Regional has the only highly specialized ECMO team in the Valley from Los Angeles to Sacramento. The treatment requires intensive therapies from numerous medical professionals, including cardiologists, pulmonologists, perfusionists, specially trained critical care nurses, physical therapists and more — like the neonatal specialists who monitored the twins during Selling’s hospitalization.
Selling was on the ventilator for three weeks and ECMO for eight days before she was transitioned off the machine when her lung function improved. Each day her husband journaled what happened for her since she was sedated and unaware of her condition for weeks.
“He’d write an email with the day’s events and then email them to me. So I had the time stamp of when it happened,” she said. “He had to make decisions when I couldn’t — really hard ones — so, that takes a lot of strength.” Selling said her husband wasn’t just making decisions for her, but “all three of us.”
Mom and babies improve
Soon after starting ECMO, Selling began to show signs of improvement.
“We just couldn’t be happier. Honestly, this is why we do it,” Dr. Ives-Tallman said. “It’s the reason we come in every single day. Not everyone has such a wonderful outcome.”
During her hospitalization, specialized teams came in to monitor and care for Selling and the twins. Her physical therapists started working with her as soon as she was admitted — even though she was not aware. Such movement therapy improves and shortens recovery for patients who are immobilized for long periods in the ICU.
“I know they did it, I have pictures that prove they did,” Selling said of her treatment while she was on the ventilator and ECMO. “I got intubated and then I was kinda out.”
Healing after ECMO
Selling had lost a month of memories during her time on the ventilator and ECMO.
“I was just catching up. I was confused. I didn’t know how long I’d been asleep. Where I was. What had happened, the babies … so it was a lot of catch up,” she said. “It’s crazy how many people were in that ICU trying to keep me alive.”
Selling said she received “incredible” care and has a thank-you list two pages long for everyone who helped her and her babies survive — nurses, therapists, doctors — and of course her husband.
To show her gratitude, Selling returned to Community Regional a few weeks after her discharge to donate 50 iPads so patients can connect with family while they’re in isolation.
“Because I have 2-year-old, it was super important for her to see my face … I wanted to remain present in her life,” Selling explained. “So during the 7 weeks I was here, the iPad I had in the hospital gave me the ability to do that.”
Selling felt it was important to give back. “This hospital saved my life. So what better way to say thank you than to let other patients have the same amenities I had,” she explains.
Planning for the twins’ birth
“They’re very passionate about their work. I mean, this experience made me want to deliver here [at Community Regional] now,” Selling said. “Especially because they have a great NICU, and I’m having twins and the likelihood of a NICU stay is pretty high. And I’d rather be here because I know the level of care I’m going to get.”
Community Regional’s neonatal intensive care unit is one of the highest ranked — Level 3 — in the Valley and accepts transfers from other hospitals in the region for moms and babies needing a higher level of care. For nearly a decade, Community Regional has delivered the most micro-preemies — weighing less than 3 lbs. 5 oz. — in California and has developed special expertise in caring for these fragile newborns.
Selling spent a total of 49 days in the hospital before being discharged. She missed her family and home.
“They’re [the twins] coming in April, and I hope that’s the next time I see this place,” she says with a laugh. “Although it’s been a great experience, I can wait until April to come back!”
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