An incorrectly placed breathing tube could have contributed to the death of a 13-year-old boy who became the UK’s first known child victim of Covid-19, a doctor has told the inquest into his death.
Ismail Mohamed Abdulwahab, of Brixton in south London, died of acute respiratory distress syndrome caused by coronavirus pneumonia in the early hours of 30 March 2020, three days after testing positive for the virus.
He was admitted to King’s College hospital in London after developing a fever, coughing, shortness of breath, vomiting and diarrhoea, and he had a cardiac arrest before he died.
Hours before his death, an endotracheal tube – which is used to help patients breathe – was found to be in the wrong position and a decision was made to leave it and monitor him.
The inquest at London Inner South coroner’s court is examining whether the endotracheal tube should have been repositioned.
Dr Tushar Vince, a consultant in paediatric intensive care at the hospital, treated Ismail when he had already been intubated.
Giving evidence via video link, Vince said the fact that the breathing tube was in the wrong position could have contributed to the teenager’s death.
When asked by the coroner if it would be reasonable to put the positioning of the tube on the death certificate as one of the causes, Vince said: “I think it would be reasonable to consider it, yes.”
She said the fact the tube was not in its correct place contributed to the cardiac arrest “at a basic level”.
The court heard that the consultant saw an X-ray of Ismail’s chest. When asked what it showed about the position of the tube, she said: “It’s too high.”
She added: “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.”
Anuj Khatri, another paediatrician, pointed out to Vince at about 9.30pm that the tube was too high, and after a conversation about the risks of moving or not moving it, Vince decided not to reposition it, the court heard.
During his evidence, Khatri told the court he did not agree with his colleague’s decision. He said he believed the situation was “urgent” because the tube could get dislodged, which was “potentially life-threatening for a patient who is sedated and paralysed” on muscle relaxants.
Vince told the court that a dislodged tube in previously fit and healthy children should not “easily” lead to cardiac arrest.
The court heard how Ismail was one of the first children with coronavirus that Vince had treated. 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.”
Vince added: “It was terrifying being there.”
A statement made by Ismail’s eldest sister, read out in court, described the teenager as a “kind and genuine soul”. She 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.”
The inquest continues.
