The lack of a 24/7 catherisation laboratory at University Hospital Waterford (UHW) had no impact on the survival chances of a farmer who died while being transferred by ambulance to Cork, an inquest has heard.
Dr Ross Murphy, a consultant cardiologist at St Vincent's Hospital in Dublin, reviewed the treatment of Thomas Power (40) at University Hospital Waterford when he presented there on June 18th, 2017.
He found that Mr Power had suffered such a severe tear to his heart muscle that only immediate full open heart surgery could have saved him.
Speaking after the inquest, Mr Power’s widow Bernadette urged the Government to improve cardiac services in the southeast. She called for the provision of a second cath lab at UHW so as to provide 24/7 cardiac cover.
Mr Power’s parents, Michael and Eileen, and his sisters, Joan and Catherine, said the deceased was disadvantaged by the lack of proper cardiac services in Waterford.
"He did not have access to a full cardiac centre – give this to the people of the southeast, it's what they deserve and give it to them now," the family said after Cork City Coroner, Philip Comyn, extended his sympathies on their loss.
Dr Murphy had earlier acknowledged that the cath lab was open at UHW between 9am and 5pm on Monday to Friday to provide procedures such as stenting but that the hospital did not offer full cardiac thoracic surgery, which is only available at hospitals in Dublin, Cork and Galway.
Significantly weakened
The inquest at Cork City Coroner's Court heard from assistant State pathologist Dr Margaret Bolster, who said that Mr Power had suffered a heart attack some three to seven days before presenting with pains in his chest at UHW on June 18th. This had significantly weakened his heart muscle and subsequently led to a rupture, she said.
Dr Bolster said that the risk of rupture is greater after a heart attack as the tissue is weakened, and the rupture in Mr Power’s case led to a large amount of blood – around 400ml – gathering around the heart which would affect its ability to pump blood.
Dr Murphy said a 3cm rupture was so severe that stenting was not an option and Mr Power would either have had to have the blood drained immediately with a tap or undergo full open heart surgery within two to five minutes at a full cardiac surgery centre to have had any chance of survival.
The only designated cardiac surgery centres are at the Mater Hospital and St James's Hospital in Dublin; Cork University Hospital; and University Hospital Galway.
Dr Murphy’s opinion was by echoed by interventional cardiologist at UHW, Dr John O’Dea, who said that the rupture in Mr Power’s case was so severe that he required full open heart surgery but even then there was no guarantee of survival.
Both Dr Murphy and Dr O’Dea said the fact that medical staff and paramedics in the ambulance carrying Mr Power to CUH ran out of adrenaline after administering six doses was of no consequence as adrenaline and CPR were of no use in the case of such a severe heart rupture.
Bernadette Power said her husband phoned her at around 10.30am on the morning of June 18th to say he had pains in his chest. She collected him at their farm at Bell Lake near Dunmore East and drove him to UHW, where he was admitted 11.25am.
‘Love you’
After he underwent two electrocardiographs in the emergency department, the couple were told Mr Power was being transferred by ambulance to CUH.
Ms Power said she left to travel ahead and that her last words to him were “Love you, see you in Cork.”
The inquest heard that Mr Power had been triaged as a category orange case, to be seen by a doctor within 10 minutes, and he was later prepared for transfer by ambulance to Cork as the cath lab in Waterford is not open on Sundays. The ambulance left UHW at 12.10pm.
Mr Power’s condition was stable at the time and he was given oxygen en route but at 12.45pm his condition changed and they could find no carotid pulse. He was given CPR and adrenalin but at 1.18pm his heart beat flatlined.
The ambulance staff ran out of adrenaline at 1.18pm but they met another ambulance in Midleton at 1.33pm, from which they were given more adrenaline. They continued CPR until they reached CUH but Mr Power was pronounced dead shortly after arrival at 1.51pm.
The jury returned a verdict of death by natural causes. While recognising the lack of adrenaline was not a factor in Mr Power's death, the jury recommended that Minister for Health Simon Harris carry out a review of hospital resuscitation packs in ambulances transferring patients.
