Source · Prevention of Future Deaths
Beryl Walters
Ref: 2014-0489
Date: 11 Nov 2014
Coroner: Andrew Thompson
Area: Black Country
Responses identified: 0 / 2
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Cyclizine, a medication with known cardiac risks in severe heart failure, was unnecessarily administered despite a safer alternative being available, posing avoidable patient harm.
Date
11 Nov 2014
56-day deadline
6 Jan 2015
Responses identified
0 of 2
Coroner's concerns
Cyclizine, a medication with known cardiac risks in severe heart failure, was unnecessarily administered despite a safer alternative being available, posing avoidable patient harm.
View full coroner's concerns
[IL1: PROTECT] [IL1: PROTECT] (1) The British National Formulary states in the cautions part of the section on Cyclizine “severe heart failure; may counteract haemodynamic benefits of opioids;…”
(2) The paper attached, whilst itself drawing the reader’s attention to the possible non-transferability of the findings to the emergency department, and the limited group of patients the original 1988 study was based on, makes a recommendation not to use Cyclizine in these circumstances.
(3) The availability of an alternative antiemetic, Metoclopramide, which does not appear to share the same cardiac risk profile, would seem to suggest that the use of Cyclizine is an unnecessary risk in these circumstances.
(2) The paper attached, whilst itself drawing the reader’s attention to the possible non-transferability of the findings to the emergency department, and the limited group of patients the original 1988 study was based on, makes a recommendation not to use Cyclizine in these circumstances.
(3) The availability of an alternative antiemetic, Metoclopramide, which does not appear to share the same cardiac risk profile, would seem to suggest that the use of Cyclizine is an unnecessary risk in these circumstances.
Report sections
Investigation and inquest
On 27 June 2014, I commenced an investigation into the death of Beryl WALTERS. The investigation concluded at the end of the inquest on 11 November 2014. The conclusion of the inquest was the deceased died from 1a. Myocardial Infarction and mitral valve disease; 1b. Coronary artery thrombosis; 1c. Coronary artery atherosclerosis; 2. Cyclizine administration. My conclusion was Natural Causes
Circumstances of the death
1. Mrs Walters presented at A&E with an atypical history of chest pain
2. An ECG showed a posterior Myocardial Infarction.
3. According to the local pathway she was given an antiemetic (Ccyclizine) as she reported feeling sick. The pathway did not at that time specify which anti-emetic should be given, and during the evidence heard it transpired that in the hospital concerned, Cyclizine was widely used in these circumstances.
4. Very shortly after the administration of Cyclizine Mrs Walters went very hypotensive and tachycardic, and then suffered a Cardiac Arrest from which she could not be resuscitated.
5. At Post Mortem, there was evidence of severe Right Coronary Artery occlusion by atheroma, with appearances consistent with early infarction in the posterolateral part of the left ventricular wall.
6. The reporting pathologist drew my attention to the existence of a paper from 2006 (attached) the conclusion of which was “Cyclizine should be avoided in patients with acute coronary events”.
7. The hospital concerned has now revised their pathway in the light of these circumstances to advise the use of Metoclopramide as the first line anti-emetic in patients with acute coronary events.
2. An ECG showed a posterior Myocardial Infarction.
3. According to the local pathway she was given an antiemetic (Ccyclizine) as she reported feeling sick. The pathway did not at that time specify which anti-emetic should be given, and during the evidence heard it transpired that in the hospital concerned, Cyclizine was widely used in these circumstances.
4. Very shortly after the administration of Cyclizine Mrs Walters went very hypotensive and tachycardic, and then suffered a Cardiac Arrest from which she could not be resuscitated.
5. At Post Mortem, there was evidence of severe Right Coronary Artery occlusion by atheroma, with appearances consistent with early infarction in the posterolateral part of the left ventricular wall.
6. The reporting pathologist drew my attention to the existence of a paper from 2006 (attached) the conclusion of which was “Cyclizine should be avoided in patients with acute coronary events”.
7. The hospital concerned has now revised their pathway in the light of these circumstances to advise the use of Metoclopramide as the first line anti-emetic in patients with acute coronary events.
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Report details
- Reference
- 2014-0489
- Date of report
- 11 November 2014
- Coroner
- Andrew Thompson
- Coroner area
- Black Country
Responses identified
Responses identified
0 of 2
2 responses not yet linked
Organisations named in PFD reports are normally expected to respond within 56 days. Deadline: 6 Jan 2015.
Sent to
- College of Emergency Medicine
- National Institute for Clinical Excellence