Access to a cath lab would not have saved a farmer whose death during a hospital transfer following a complication of a “silent heart attack” sparked outrage over cardiac services in the South-East, it has emerged.
Thomas Power, aged 39, of Woodstown, Co Waterford, died in an ambulance on the Waterford to Cork road on Sunday, June 18, from a massive tear in his heart wall — a late complication of a silent heart attack which could have occurred several days earlier, an inquest into his death established yesterday.
Cork City Coroner’s Court was told that the so-called Protocol 37 intra-hospital transfer, from University Hospital Waterford (UHW) to Cork University Hospital (CUH) was required because the UHW cath lab services operate 9am to 5pm Monday to Friday only.
Mr Power’s death sparked a massive campaign for improved cath lab services in the South-East.
However, the inquest was told that the tear in his heart was so severe that urgent open heart surgery within two to five minutes would have been his only hope.
This surgery could only have been performed at one of the country’s four cardiac centres: The Mater, St Jame’s, Galway, or Cork. And even at that, his chances of survival would have been slim.
Mr Power’s widow, Bernadette, told coroner Philip Comyn that building work on their home was almost finished, that they had discovered a week before that they were expecting a baby, and that he had only been to a doctor once — to remove a thorn from his left thumb.
She fought back tears as she explained that Mr Power had been in good form and hadn’t complained of ill-health in the days before.
“He was doing normal physical work on the farm,” said Bernadette. “Nothing fazed him.”
But at around 11am that Sunday, she said, he phoned her from the farm complaining of chest pains.
They arrived at UHW emergency department at 11.25am, where he was seen immediately, and diagnosed as having a heart attack.
Dr Laura Murphy performed an echocardiogram which showed decreased heart muscle motion, but did not reveal any leaking fluid around the heart, and blood tests ruled out the administering of the clot-busting drug, thrombolysis.
Because the hospital’s cath lab is closed at weekends, a Protocol 37 ambulance transfer to CUH’s cath lab was arranged.
Mr Power was deemed stable enough to be transferred at 12.10pm and was accompanied by clinical nurse manager Mary Dunne and Dr Clare Moore in the ambulance.
Bernadette made the journey separately by car. She said her last words to her husband were: “Love you — see you in Cork.”
Ms Dunne brought a medical pack, which included six doses of special adrenalin, for the journey. She said Mr Power was conscious and talking but she advised him to rest once they passed a series of roundabouts on the outskirts of Dungarvan.
But she noticed a sudden deterioration in Mr Power’s condition at 12.45pm and he flat-lined. The ambulance stopped and Ms Dunne and Dr Moore began CPR. He did not respond. They attached a Lucas mechanical CPR machine to his chest and the ambulance set off again at 1pm. Mr Power did not respond.
They administered adrenalin every five minutes, as per protocols, and Ms Dunne said that when she was down to her last vial, she called for another ambulance to meet them with new supplies.
They met that ambulance at Midleton at 1.35pm but there was an 18-minute gap when no adrenalin was administered.
The ambulance arrived at CUH at 1.50pm where CPR continued, but Mr Power was pronounced dead a short time later.
Bernadette said: “He had a pain in his chest but nothing I thought he’d die from. When I was leaving the hospital, I thought I was going to see Tom alive in Cork.”
Dr Margot Bolster said an autopsy revealed that Mr Power had suffered a heart attack between three and seven days earlier, caused by hardening of an artery, which made the heart wall vulnerable to rupture.
She found a 3cm tear in the heart wall which allowed 400ml of blood to pour into the sack around the heart, compressing it and causing death.
When asked about the silent heart attack and why Mr Power hadn’t complained days before, she said: “I see this very often — this is not an unusual situation.”
Consultant cardiologist Dr Ross Murphy, who reviewed the case, told Mr Comyn that the so-called free-wall rupture is “one of the most feared mechanical complications” of a heart attack. He said the only option for Mr Power at that stage would have been to drain the fluid, or open cardiac surgery within two to five minutes, which could only have been performed in one of the country’s four cardiac centres.
“This was going to happen at a certain stage,” he said. “You can die from a quarter centimetre tear. I’ve never seen one as big as this.”
The presence or otherwise of a 24-hour cath lab service in Waterford would not have affected the risk to Mr Power of a free-wall rupture, Dr Murphy added.
He also said it is quite possible for 5%-10% of the population to suffer a heart attack without experiencing symptoms.
“He was strong enough to withstand it but we are dealing with the consequences of a complication of that,” he said. And he said adrenalin would have made no difference to the outcome.
The inquest was also told that there was a history of heart disease in Mr Power’s family, and that 60% ofIrish men will develop cardiovascular disease at some stage.
The inquest jury recommended that the circumstances of Mr Power’s death be brought to the attention of the health minister, Simon Harris.
It also recommended that the HSE review the contents of hospital resuscitation packs used during intra-hospital transfers after it was revealed that medics ran out of adrenalin when Mr Power deteriorated during the journey.
Speaking through her solicitor afterwards, Ms Power said she never thought on the day of their wedding in September 2016 that she would be attending an inquest into her husband’s death a year later.
“I am relieved to now know what caused my husband Tom’s death, after many months of wondering,” she said in a statement.
Bernadette thanked family, friends, and neighbours for their support.
“The last year has been a very difficult time for me and your support did not go unnoticed,” she said.
She thanked the staff of UHW, the ambulance paramedics, and staff at Cork University Hospital for the care they gave Tom on the day.
She also thanked UHW staff for the care and support she received during her pregnancy, and the care they gave to baby Tom when he was born on November 22.
She appealed to the media and the general public to respect her privacy so she can “grieve with dignity and in private”.