A breathing tube in the wrong position could have contributed to the death of a 13-year-old boy who became the UK’s first known child victim of coronavirus, a doctor has told an inquest.
Ismail Mohamed Abdulwahab, of Brixton, south-west London, died of acute respiratory distress syndrome, caused by coronavirus pneumonia, in the early hours of March 30 2020, three days after testing positive for Covid-19.
He suffered a cardiac arrest before he died.
He was admitted to King’s College Hospital after suffering fever, coughing, shortness of breath, vomiting and diarrhoea.
His family were not able to be with him in intensive care because of hospital policies at the time.
They were also unable to attend his funeral as they were self-isolating after some of his siblings contracted milder symptoms of high temperature and loss of taste.
Four people wearing protective clothing, gloves and face masks lowered his coffin into a south-east London grave in April 2020.
Hours before Ismail’s death, an endotracheal tube (ET) used to help patients breath was found to be in the wrong position and a decision was made to leave it and monitor him.
The teenager did not survive the night.
The inquest at London Inner South Coroner’s Court is examining whether the ET should have been repositioned.
At a basic level, clearly the fact that the tube was not in the correct place has contributed to (the cardiac arrest)— Dr Tushar Vince, King's College Hospital
Dr Tushar Vince, a consultant in paediatric intensive care at King’s College Hospital, treated Ismail on March 29.
He had already been intubated, the court heard.
Giving evidence via video-link, Dr Vince said the fact that the breathing tube was in the wrong position could have contributed to the teenager’s death.
Asked by the coroner if it would be reasonable to put the positioning of the ET on the death certificate as one of the causes, Dr Vince said: “I think it would be reasonable to consider it, yes.”
Asked what the cause of the cardiac arrest was, Dr Vince said: “At a basic level, clearly the fact that the tube was not in the correct place has contributed to this.”
The court heard that the consultant saw an X-ray of Ismail’s chest.
I was so focused on the lungs I just didn’t see how high this tube was and I’m so sorry that I didn’t see it. It was a real oversight ...— Dr Tushar Vince, King's College Hospital
Asked what it showed about the position of the tube, she said: “It’s too high.
“I fully accept I just didn’t see. I was so focused on the lungs I just didn’t see how high this tube was and I’m so sorry that I didn’t see it.”
She added: “It was a real oversight that I did not see the tip of this tube.”
Another paediatric doctor, Anuj Khatri, pointed out to Dr Vince at around 9:30pm that the tube was too high but, following a conversation about the risks of moving and not moving the ET, she decided not to reposition it, the court heard.
Dr Vince told the coroner that she had to consider the consequences of intervening when Ismail was in a “prone” position – on his front – and concluded that it was a “safer option” to leave him be and monitor him rather than flip him onto his back to move the tube.
The court heard that Ismail was “improving” at the time.
We all thought we were going to die by being in contact with Covid. We all thought that the worst could happen and that we might take it home to our families and that we might kill them. It was terrifying being there— Dr Tushar Vince, King's College Hospital
During his evidence, Dr Khatri told the court he did not agree with his colleague’s decision.
He said he believed the situation was “urgent” because the highly placed tube could get dislodged which was “potentially life-threatening for a patient who is sedated and paralysed” on muscle relaxants.
Dr Vince went on to tell the court that a dislodged tube in previously fit and healthy children should not “easily” lead to cardiac arrest.
“So is it actually he was much sicker than we thought?” she asked.
“Or maybe the tube was not in the right place and he was just holding on for a long time. But I don’t understand then why his parameters were improving if the tube was not in the right place.”
Professor Akash Deep, a leading paediatric consultant, said the “dislodged” tube was a “tipping point” for Ismail’s death.
Giving evidence, he said he would add “misplacement of the ET” as well as “high BMI” onto the death certificate.
He also explained that movement of Ismail could have caused the breathing tube to reposition higher up the boy’s trachea, and curl in the back of his mouth, without changing its position externally.
The court heard how Ismail was one of the first children suffering with coronavirus that Dr Vince had treated.
Once we arrived (at the hospital) we were met with the dreadful, shocking and sad news of (Ismail's) passing. We are overwhelmed with grief by his passing— Statement made by Ismail's eldest sister
She said: “We all thought we were going to die by being in contact with Covid. We all thought that the worst could happen and that we might take it home to our families and that we might kill them.”
“It was terrifying being there,” she added.
Senior Coroner Andrew Harris gave the “provisional opinion” that he cannot apply “neglect” to the incident but has adjourned the hearing until Thursday for judgment.
A statement made by Ismail’s eldest sister, read out in court, described the teenager as a “kind and genuine soul”.
She said her brother first fell ill on March 23 2020, that his shortness of breath worsened two days later prompting them to call 111 and that the family phoned emergency services on March 26 after which Ismail was taken to hospital in an ambulance.
On March 27, he was put into intensive care and tested positive for Covid-19.
The family kept in touch with the ward over the next few days via telephone as they were not allowed to be there in person, the statement went on.
Finally, his sister said they received a call hours before his death requesting that a family member come to see Ismail.
“Once we arrived we were met with the dreadful, shocking and sad news of his passing,” his sister said.
“We are overwhelmed with grief by his passing.”
