Breathing tube error may have contributed to death of first child Covid victim, inquest told

The funeral of Ismail Mohamed Abdulwahab (PA Archive)
The funeral of Ismail Mohamed Abdulwahab (PA Archive)

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 Covid-19, an inquest has been told.

Ismail Mohamed Abdulwahab, from Brixton, died of acute respiratory distress syndrome, caused by Covid-19 pneumonia, in the early hours of March 30, 2020.

His death, which occurred in the first week of the national lockdown, came just three days after testing positive for Covid-19.

Ismail was admitted to King’s College Hospital (KCH) after suffering fever, coughing, shortness of breath, vomiting and diarrhoea. On March 27, he was taken into intensive care and tested positive for the virus.

His family were not able to be with him in intensive care because of rules outlawing hospital visits at the time.

They were also unable to attend his funeral as they were self-isolating after his siblings contracted a high temperature and loss of taste, both Covid-19 symptoms.

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.

An inquest held at London Inner South Coroner’s Court is examining whether the ET should have been repositioned.

Dr Tushar Vince, a consultant in paediatric intensive care at KCH, 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."

Pressed on 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 consultant was shown an X-ray of Ismail’s chest in court and said that the position of the tube was “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."

A mourner watches as the coffin is lowered into the ground during the funeral of Ismail Mohamed Abdulwahab (PA)
A mourner watches as the coffin is lowered into the ground during the funeral of Ismail Mohamed Abdulwahab (PA)

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.

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.

A statement made by Ismail's eldest sister, read out in court, described the teenager as a "kind and genuine soul".

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.

They later 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."