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Finding into death of Le Hue Huynh

Deceased

Le Hue Huynh

Demographics

46y, female

Date of death

2017-01-25

Finding date

2018-11-09

Cause of death

hypoxic ischaemic encephalopathy complicating cardiorespiratory arrest in the setting of acute asthma attack

AI-generated summary

Mrs Le Hue Huynh, 46, died from hypoxic ischaemic encephalopathy complicating cardiorespiratory arrest during the November 21, 2016 Thunderstorm Asthma event in Melbourne. She had known asthma with poor medication compliance, was highly sensitized to rye grass pollen, and had hay fever. She called 000 at 6:42pm during unprecedented demand (2,332 calls in 12 hours, 397 in 30 minutes), and her family transported her to hospital where she was found in cardiac arrest. Prolonged resuscitation caused hypoxic brain injury. Clinical lessons: patients with asthma and hay fever, particularly those uncontrolled on reliever-only therapy, faced highest risk. Better preventer medication compliance, asthma action plans, allergy testing, and remaining indoors during TA warnings could have been protective. The emergency response system was overwhelmed despite appropriate surge management and inter-agency coordination.

AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.

Specialties

emergency medicineintensive carerespiratory medicineallergy and immunologyparamedicine

Error types

systemdelay

Drugs involved

salbutamolseretide 500/50mgbudesonideadrenalineprednisoloneipratropiumantihistamines

Clinical conditions

asthmasevere allergic asthma with allergen-induced exacerbationhay fever (seasonal allergic rhinitis)asthma exacerbationcardiorespiratory arresthypoxic ischaemic encephalopathypulmonary oedemaaspiration pneumoniaanaphylaxis (historical to kiwifruit)

Procedures

intubationcardiopulmonary resuscitationvideo laryngoscopy

Contributing factors

  • thunderstorm asthma event with unprecedented surge in ambulance demand
  • poorly controlled asthma with sub-optimal preventer medication use
  • reliance on reliever medication (salbutamol) without regular inhaled corticosteroid
  • high sensitization to rye grass pollen
  • hay fever
  • absence of asthma action plan or management plan
  • no lung function testing despite history of exacerbations
  • exposure to outdoor environment during thunderstorm asthma event
  • delayed ambulance response due to system-wide surge
  • rapid onset severe asthma attack (approximately 15 minutes from complaint to respiratory arrest)
  • difficult intubation with prolonged resuscitation time

Coroner's recommendations

  1. Further research into the specific meteorological, biological and aerobiological factors that combine to create thunderstorm asthma events to improve predictability and forecasting accuracy
  2. Continued development and verification of the thunderstorm asthma forecasting system
  3. Continued public awareness campaigns by DHHS regarding thunderstorm asthma, asthma action plans, and the link between hay fever and thunderstorm asthma
  4. Further medical, allied health and community education encouraging hay fever sufferers to undergo allergy testing to understand their susceptibility to thunderstorm asthma and inform clinical management
  5. When a thunderstorm asthma warning is issued, those at risk should remain indoors with windows and doors shut, turn off evaporative cooling or systems that draw in outside air, and/or travel to/from work later
  6. Address the current limitation that callers during high-demand periods cannot receive estimated time of arrival information for ambulances to enable informed decisions about alternative transport to hospital

Further listening

Coronial podcast — Episode 93

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