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The night before she was scheduled to have an elective cesarean section, Tania Melendez went out to eat with her family to celebrate. The 37-year-old Hazleton woman had noticed swelling in her feet and legs and shortness of breath, but she’d experienced these common pregnancy symptoms before with her first two children.
“I wasn’t worried because I’ve always been healthy with no chronic conditions,” Melendez says.
That evening, Jan. 8, 2017, her water broke, and her sister-in-law rushed her to Lehigh Valley Hospital (LVH)–Hazleton to have her C-section. The baby – a boy named Eudez – was born healthy.
Everything seemed normal, but afterward, while Melendez was still in the operating room (OR), she began having trouble breathing and quickly went into cardiac arrest. She remembers nothing after that.
Code blue
Brenda Noonan, RN, and Amanda Kalinowski, RN, rushed to the OR as soon as they heard the emergency announcement and began CPR (cardiopulmonary resuscitation). Once a patient’s heart and breathing has stopped, every second counts. It’s crucial to keep enough oxygen-rich blood circulating through the body to prevent brain damage or death before a heartbeat can be reestablished.
“We didn’t know what was wrong, but I started chest compressions, and the team gave her oxygen and medications to restore blood circulation,” Noonan says. “It was traumatic wondering if her beautiful baby would grow up without a mother.”
The team worked frantically and revived a slight pulse, but Melendez’s blood pressure remained so low they knew she required additional help. “The decision was made to airlift her to Lehigh Valley Hospital–Cedar Crest for special life-support called extracorporeal membrane oxygenation (ECMO) that works like an artificial heart and lung,” Kalinowski says.
Lifesaving resuscitation
Cardiothoracic surgeon Sanjay Mehta, MD, with LVPG Cardiac and Thoracic Surgery, was in the intensive care unit in the early-morning hours of Jan. 9 when Melendez arrived by MedEvac helicopter. “The team did a wonderful job keeping her functioning on the journey here,” he says.
Mehta and his staff first believed Melendez had a rare lung condition called amniotic fluid embolism that affects women during delivery. They quickly put her on the ECMO machine to support just her lungs, hoping her heart would start beating again automatically. But when it failed to respond, they concluded Melendez had peripartum cardiomyopathy, a type of heart failure that can occur during pregnancy or after delivery. Common symptoms include water retention and shortness of breath. Mehta upgraded ECMO to take over her heart function too.
For three days, Melendez remained on ECMO under sedation to keep her comfortable and eliminate accidentally pulling out her tubes. No one knew if she would recover, or what disabilities she might face afterward.
Miraculously, Melendez’s heart began beating again by itself. She was removed from ECMO after three days, but remained on a ventilator for nearly two more weeks to ensure she was breathing properly. She returned home on Jan. 25.
“This was a real team effort,” Mehta says. “Many people deserve credit for getting her through this.”
Remarkable recovery
Today, Melendez is walking and talking, and suffers only lingering effects from her traumatic experience. Baby Eudez is also thriving, and her two daughters and husband are thrilled to have her back.
After developing a thrombosis (blood clot) in her right arm, Melendez experienced hand weakness. Her treatment includes taking a blood thinner medication to reduce risk for another clot and receiving occupational therapy at the Health & Wellness Center at Hazleton. She also has follow-up care with hematologist Harvey Hotchner, MD, with LVPG Hematology Oncology, and cardiologist Thomas Ciotola, MD, with LVPG Cardiology.
Melendez still feels emotionally shaky sometimes, but she’s beyond grateful for the care she received from LVHN’s regional team.
“I’m astonished I’m alive when I hear what happened and what everyone had to do to save me,” she says.