Finding into death of Trevor Ronald McDonald

43y · Male·Hypoxic brain injury secondary to haemopericardium and tamponade complicating ruptured right coronary artery during coronary angioplasty

Mr Trevor McDonald, 43-year-old male, died from hypoxic brain injury following cardiac tamponade complicating coronary angioplasty. During elective PCI at Frankston Hospital, he sustained right coronary artery perforation causing pericardial bleeding and tamponade. Following initial pericardiocentesis, he likely suffered laceration of the right ventricular outflow tract (RVOT), possibly from the drainage needle inserted without ultrasound guidance. Despite resuscitation and emergency transfer to a tertiary cardiac centre, he suffered irreversible hypoxic brain injury. Key clinical lessons: (1) complications of PCI in regional facilities without on-site cardiac surgery incur significant time delays for definitive surgical management; (2) emergency pericardiocentesis carries risk of vessel injury, particularly when performed without imaging guidance; (3) prolonged cardiac tamponade causes incremental cerebral hypoxia; (4) all interventional cardiologists should maintain expertise in emergency tamponade management and have cross-accreditation with cardiac surgical centres; (5) robust inter-hospital transfer protocols are essential.