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Nightingale Hospital death: Wrong filter caused cardiac arrest in Covid patient

Getty Images Nightingale hospitalGetty Images
Kishorkumar Patel was transferred to the Nightingale Hospital three weeks before his death

A coronavirus patient at a Nightingale Hospital died "in small part" because his ventilator was fitted with the wrong filter, an inquest has found.

Kishorkumar Patel, 58, died at the temporary hospital built at the ExCel centre in east London on 26 April 2020.

His medical cause of death was multiple organ failure and Covid-19 pneumonitis.

Mr Patel also suffered a cardiac arrest after an incorrect filter was used in his ventilator East London Coroner's Court found on Tuesday.

Senior coroner Nadia Persaud found the packaging used on the filters "was not clear".

This led to a "dry filter" being used by mistake, leading to a cardiac arrest and a decline in kidney function, Ms Persaud said.

Mr Patel was married with six children and had a healthy BMI (body mass index), the court heard.

Ms Persaud told the court he had no underlying health conditions, and he regularly practised martial arts, swimming and jogging.

Getty Images Beds at Nightingale HospitalGetty Images
Staff at the Nightingale Hospital were confused by the colour coding used on filter packaging, the coroner found

He began suffering with coronavirus symptoms including difficulty breathing on 18 March last year.

On 4 April he was admitted to Northwick Park Hospital in Harrow, north London, where doctors recorded he was suffering with "severe Covid-19 disease".

The next day he was transferred to the temporary hospital at the ExCel Centre "due to the overwhelming number of patients requiring ICU (intensive care unit) care" at Northwick Park, Ms Persaud said.

Mr Patel was placed on a ventilator on 7 April and his condition was largely stable for five days. On 12 April he suffered a cardiac arrest and a decline in kidney function.

"This seems likely to have been due to the blocked tracheal tube, and it is likely that a dry filter had been used in error," Ms Persaud told the court.

"Mr Patel died as a result of an overwhelming Covid-19 disease, but his death was in small part contributed to by a lack of a heat and moisture exchange in his ventilator circuit caused by use of an incorrect filter."

In her Action to Prevent Future Deaths report published on earlier this year, Ms Persaud said there had been "a cluster of similar incidents" at the hospital but the issue was "not confined to the Nightingale".

Ms Persaud added in the report that the "confusion over breathing system filters" is "widespread among ICU doctors and nurses".