(BPT) - When fourth-grade teacher and new mom Brianna Iacona caught COVID-19 weeks before her 30th birthday, her mild symptoms rapidly escalated into life-threatening respiratory failure. After 97 days in the intensive care unit (ICU) and a double lung transplant, she made a remarkable recovery and is now back in the classroom and enjoying time with her family.
Anesthesiologists were there every step of her medical journey — from providing intensive daily care and resolving life-threatening complications in the ICU to safely guiding her through the eight-hour high-risk transplant.
"I didn't realize until after my transplant how critical each health care professional's role is and that anesthesiologists were involved in so much of my care," said Brianna, 34, of Newark, Del. "They were amazing."
From the brink of death to a new beginning
After her son Brayson's birth, Brianna returned to the classroom in the fall of 2021. A few weeks into the school year, she tested positive for COVID and got progressively worse. When she lost consciousness, her husband called for an ambulance. At the hospital, she was placed on extracorporeal membrane oxygenation (ECMO), a life support system that takes over the work of the lungs and heart. After two weeks, she was airlifted to the Penn Medicine: University of Pennsylvania Health System, Philadelphia.
In the ICU, anesthesiologists were at her bedside daily, keeping her stable on long-term ECMO, addressing the crises that threatened her survival and updating her family daily. They monitored and adjusted her medications, oxygen levels and blood thinners, coordinated her nutrition, and managed complications such as a collapsed lung. When blood thinners didn't break up a dangerous clot in her heart, they alerted the surgeon to remove it. They advocated for her to be considered for lung transplantation and provided rehabilitation to keep her strong enough for the surgery.
She remembers almost nothing from her COVID diagnosis to her transplant — not the hospital staff decorating her bed for her birthday, the surgery to remove the blood clot or visits from her husband and son. Only a few fragments remain: the sensation of pedaling a bike during rehab, watching a movie in the hospital, and the anesthesiologist gently talking to her about her trauma and asking how to make her more comfortable.
On Dec. 28, 2021, she had a double lung transplant. Anesthesiologist Bonnie Milas, M.D., guided her through the complex surgery, monitoring and adjusting her ECMO support, keeping her stable and managing her oxygen levels. After the surgery, she carefully weaned Brianna off ECMO.
"Without that ongoing, intensive day-to-day management in the ICU, she might not have made it to surgery," said Dr. Milas, who is a professor of anesthesiology and critical care medicine at the University of Pennsylvania and a member of the American Society of Anesthesiologists' Committee on Trauma and Emergency Preparedness. "We were able to take her off ECMO after surgery when we knew her new lungs could do the job on their own."
A long recovery and back to the classroom
After spending a month in the hospital relearning to walk, speak and dress herself, she came home in March 2022, shortly after Brayson's second birthday. She continued outpatient physical therapy for three months, and by May finally felt strong enough to care for her son by herself. That fall, she returned to teaching.
"When you go through a traumatic experience like this, you lose your identity," said Brianna. "You just want to get back to who you are. I love teaching. It's who I am."
Every year on Dec. 28, she, her husband and son sing "Happy Birthday" to her new lungs. "Brayson knows the transplant saved my life," she said.
"People think anesthesiologists are only in the operating room, but in cases like this, we're keeping patients alive in the ICU day after day and are often the reason they get a second chance at life," said Dr. Milas. "In the operating room, a lung transplant is a choreography of high-risk decisions, with the anesthesiologist maintaining blood flow, preventing injury, stabilizing the patient and ensuring those new lungs are viable the moment they are transplanted."
