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Finding into death of Ling-Ling Ang

Deceased

Ling-Ling Ang

Demographics

47y, female

Date of death

2016-11-25

Finding date

2018-11-09

Cause of death

hypoxic ischaemic encephalopathy complicating systolic cardiac arrest in the setting of asthma

AI-generated summary

Ms Ling-Ling Ang, aged 47, died from hypoxic ischaemic encephalopathy and cardiac arrest following severe allergic asthma exacerbation during the November 2016 Melbourne thunderstorm asthma epidemic. She had known asthma and hay fever but took sub-optimal preventer medication; post-mortem testing showed high sensitization to rye grass pollen. On 21 November, during severe thunderstorms, she experienced acute respiratory distress at home, lost consciousness en route to a clinic. Bystanders initiated CPR; an ambulance arrived at 6:42pm and transferred her to Northern Hospital. Despite intubation, mechanical ventilation, and ICU care, she suffered recurrent cardiac arrests and multi-organ failure, dying three days later. Clinical lessons include: ensuring asthma patients understand their allergy status and sensitizations; optimizing preventer medication use; developing asthma action plans; recognizing severe asthma warning signs; patient education about thunderstorm asthma risks; and health system preparedness for mass surge events.

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

Specialties

general practiceparamedicineemergency medicineintensive carerespiratory medicineallergy and immunology

Drugs involved

salbutamolfluticasone/salmeterolprednisolone

Clinical conditions

asthmaallergic asthmahay feverseasonal allergic rhinitisacute asthma exacerbationrespiratory arrestsystolic cardiac arresthypoxic ischaemic encephalopathybronchoconstrictionpneumothoraxmulti-organ system failure

Procedures

cardiopulmonary resuscitationendotracheal intubationtibial interosseous cannulationautomated CPR machineintercostal catheter insertionmechanical ventilationrenal replacement therapy

Contributing factors

  • Severe allergic asthma exacerbation
  • Thunderstorm asthma event
  • High sensitization to rye grass pollen
  • Sub-optimal preventer medication use
  • Hay fever / seasonal allergic rhinitis
  • Outdoor exposure during thunderstorm
  • Rapid onset of bronchospasm

Coroner's recommendations

  1. Further research into meteorological, biological and aerobiological factors creating thunderstorm asthma events
  2. Further verification and development of thunderstorm asthma forecasting system
  3. Continue and expand public awareness campaigns about thunderstorm asthma and its link to hay fever
  4. Expand medical and allied health professional education about hay fever, asthma, and thunderstorm asthma risk
  5. Encourage hay fever sufferers to undergo allergy testing to understand sensitization risk
  6. Develop specific asthma management plans for those with hay fever or seasonal asthma exacerbations
  7. Public health messaging recommending those at risk remain indoors with windows and doors closed during thunderstorm asthma warnings
  8. Recommend turning off evaporative cooling and air intake systems during thunderstorm asthma warnings
  9. Develop systems to provide estimated time of arrival information to emergency ambulance callers during surge events

Further listening

Coronial podcast — Episode 93

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