COVID survivor has long road of recovery after last resort treatment

Keish Pares of Northumberland had to have ECMO treatment at Geisinger in Danville as part of her treatment for her COVID-19 infection. The scars on her neck are a result of the treatment and having a tracheotomy. The Daily Item

NORTHUMBERLAND — Keish Pares survived COVID-19, but just barely.

As a survivor, having spent two months as a critically ill patient at Geisinger, the 27-year-old Northumberland woman said she has a long road of recovery ahead of her. Her lungs are still not at full capacity, she still has a limp in her leg from a clotted artery, and she continues to have heart issues. The visible scars on her neck from the tracheostomy tubes and specialized treatment are a physical reminder of the damage her body has endured from the delta variant of the virus.

“I’ve only been home for a month,” said Pares on Friday. “I’m still figuring out what my life looks like now.”

Pares was one of Geisinger’s patients who received ECMO (extracorporeal membrane oxygenation) treatment, which is reserved for the most critically ill COVID patients like her. It’s considered by Geisinger specialists as a last resort treatment when all other therapies and efforts have been exhausted.

Pares, who was not vaccinated, said she was a healthy individual prior to contracting COVID-19. She didn’t have any pre-existing conditions, she was active with her husband and 8-year-old son, she spent her time riding motorcycles, jet skis and four-wheelers. She said she took precautions by spending most of her time at home with her family.

Pares said she believes she contracted the virus from a sick cashier at a local store in early October. At first, she had mild symptoms: chills and body aches. On day nine, she started coughing. On the 11th day of her quarantine on Oct. 14, she couldn’t catch her breath and she passed out.

Her mother Wanda Delgado, who happened to have an oxygenator, said she measured Pares’s oxygen levels: they were at 55 percent. Thinking the machine wasn’t working properly, Delgado measured her own oxygen levels and Pares’s husband Luis Pares Lanza’s levels and found them normal. They called 911.

Pares’s husband tried to escort her from the bedroom to the front door when the paramedics arrived, but she collapsed in the hallway.

“They put a mask over me and once I got the oxygen blasting through me, I regained some consciousness,” said Pares. “Everything was spinning. I remember them taking me out and getting in the ambulance. I was more awake. I remember telling my mom ‘I’m sorry.'”

ECMO treatment twice

Within 30 minutes at Geisinger, she was taken to the Intensive Care Unit. That morning, she called her mother at 4 a.m. with grim news.

“I said, ‘If I don’t get on a ventilator, I’m going to die,” she said.

The ECMO treatment appeared to have worked, but then her oxygen levels continued to decline. She was placed back on the ECMO machine for a second time. There were even discussions then about a lung transplant, she said.

On day 45, doctors saw improvement in her lungs. She was stable enough to be released on Dec. 16.

Now, one lung is nearly back to 100 percent, but the other is still working at 50 percent. She said her lungs will be scarred for the rest of her life.

“If I get sick, it’s going to be bad for me,” she said.

Pares said she hasn’t been able to return to work yet. Her leg is not back to 100 percent after a clot. Nerve damage means she will have to go to a specialist.

‘A last resort’

Geisinger’s Evan Gajkowski, RN and ECMO coordinator, and Matthew Bauer, ECMO specialist, said ECMO treatment is reserved for the most critically ill COVID patients. Patients who are placed on ECMO are often intubated, under intense monitoring and confined to a bed for several weeks.

Last year, from Jan. 1 to Dec. 31, Geisinger had a patient on ECMO every hour of the day, every day of the year. Fifty percent of those patients were related to COVID. Every patient on ECMO has been unvaccinated, they said.

“It’s the highest form of life support we can offer to a patient,” said Gajkowski.

For COVID patients, Bauer said the treatment is a “last resort.”

“All conventional therapy that we would normally do are failing,” said Bauer. “Either the person dies because conventional therapies aren’t working, or we put them on ECMO to give them a shot, to give them a chance.”

Advanced therapy

According to Geisinger, ECMO is an advanced therapy that delivers healthy oxygen to the blood, similar to a heart-lung machine used during surgery. This process takes place outside the body using a machine that pumps out depleted blood, oxygenates it and then pumps healthy blood back through the body.

ECMO helps a heart that has trouble pumping enough oxygenated blood to the body, or lungs that are unable to supply red blood cells with enough oxygen and remove carbon dioxide. It can support a damaged heart or lungs after recovering from surgery, after recovering from illness or disease, during a surgical procedure, while a person is waiting for a transplant. Although it typically doesn’t cure heart or lung disease, ECMO gives much-needed time to help a person’s heart and lungs heal, according to Geisinger.

During a surgical procedure, your doctor will place special tubes called ECMO cannulas into one or more large veins or arteries in your neck, chest or leg. These cannulas connect you to the ECMO machine. Using a pump, the tubing filters blood through the machine to remove carbon dioxide and replaces it with oxygen-rich blood. The pump and cannulas then return the blood back to your body, according to Geisinger.

Since the beginning of the pandemic, each hospital with an ECMO program in Pennsylvania, New Jersey, Delaware and Maryland have agreed on specific criteria to be considered for the treatment, said Gajkowski.

Patients are eligible if they are age 55 or younger and they have a Body Mass Index of less than 40. They can’t have been on a ventilator longer than seven days for COVID patients (10 days for non-COVID), Bauer said.

“Typically, if you get put on ECMO and you don’t recover, your options are either lung transplant or death,” said Bauer.

ECMO patients doubleD

The treatment was introduced at Geisinger in 2015. The hospital went from an average of 30 patients a year using ECMO pre-COVID to 60 patients a year in 2021.

For COVID patients, the shortest amount of time to come off ECMO is 15 days but it has been more than 70 days for others. It varies, said Bauer.

COVID patients spent almost double or triple the amount of time on ECMO compared to non-COVID patients, said Gajkowski.

“We are seeing patients who are so, so sick,” he said. “They are so young and take forever to get better. We are seeing them stay on so much longer.”

Every patient that Geisinger has treated with or considered for treatment with ECMO — even ones out of state or ones who have been turned down — has been unvaccinated, said Gajkowski.

Of those COVID patients on ECMO, 50 percent survive, but survival doesn’t always mean full recovery, said Bauer.

“When you say survive, some of those people who quote-unquote survive, they might be confined to having a {span}tracheotomy{/span}, oxygen therapy, be attached to a breathing device, stuck in a nursing home because they’re so debilitated,” he said. “Of those, you may have several who make a full recovery and live a normal life, but still have effects of their illness.”

He added, “We’re seeing a lot of unnecessary death.”

Specialists: get vaccinated

Gajkowski and Bauer said the best way to avoid being hospitalized from COVID is to get vaccinated.

“This is a virus,” said Gajkowski. “There is no known medication we can give a patient to kill a virus. There are therapies we can give to suppress the immune system, suppress inflammation, so your lungs don’t get sick, you don’t get pneumonia, you don’t go into multi-organ failure. No medicine kills a virus. A vaccine prevents a virus from spreading and attaching to a host.”

Pares said her outlook on COVID and vaccines has changed since getting sick. She is scheduled to be vaccinated at the end of February.

“I do regret not getting vaccinated,” she said. “I was the only one out of seven siblings who got this sick.”

Her husband was also hesitant about getting vaccinated but has also changed his mind. Their 8-year-old son Ian Pares has recently said he too wants to be vaccinated.

“He’s aware of everything,” she said. “He asks me all the time, ‘Mom, did you bring your oxygen tank just in case you get tired. Mom, is your oxygen machine on? Mom, don’t fall because you’re on blood thinners.’ He knows.”

Pares said people trust their doctors for everything else so they should trust their doctors when it comes to the vaccine.

“If they tell us we have heart problems, we go and take a pill, and we don’t even know what’s in the pill,” she said. “It’s the same thing with vaccines.”

Gajkowski said a person is “rolling the dice” if they don’t get vaccinated.

Asked what his response would be to someone who doesn’t trust vaccines, Bauer said, “I hope we don’t meet.”


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