After neck surgery, man’s breathing tube pull-out prompted brain injury – $2 Million Settlement

On April 24, 2017, the decedent was a passenger in a vehicle driven by a friend that was traveling on an interstate roadway. The driver lost control of the vehicle, which left the roadway and crashed into a ditch. As a result of the crash, the decedent sustained several cervical bone fractures.

The decedent was transported from the scene to a hospital where he underwent posterior cervical surgery that included the installation of hardware to repair the cervical fractures.

At the conclusion of the surgery, as the decedent was being extubated from the anesthesia equipment, the decedent began to flail and he reached toward his endotracheal tube (ET tube) as if he intended to pull the ET tube out of his throat. Fearing that the decedent would injure himself if he removed the ET tube, one of the anesthesia providers pulled the ET tube from the decedent’s throat. Within approximately a minute thereafter, the decedent’s heart stopped beating and he did not have a pulse.  An emergency code was called and the anesthesia team performed CPR, including chest compressions and bagged mask ventilation, for approximately eight minutes, at which time the decedent’s pulse returned.  Although the decedent’s pulse was restored, his vital signs had plummeted during the code which indicated that the decedent was not well ventilated or oxygenated while he received CPR. Due to the mismanaged extubation, the decedent sustained a hypoxic brain injury that required him to be placed on life support. The decedent never regained consciousness and he died approximately a week after the surgery when he was removed from life support.

Plaintiff’s counsel made wrongful death claims against the automobile driver and against the anesthesiology team who attended the decedent during his cervical surgery. The automobile claim settled before suit was filed for the combined liability and UIM limits of $100,000.00. The medical malpractice claim settled at mediation, after suit was filed, for $1.9 million. The applicable medical malpractice cap was $2.25 million. Thus, the combined settlement was $2 million for the decedent’s wrongful death.

The theories of liability against the anesthesia providers included an allegation that the anesthesia providers failed to appreciate and plan for all the risk factors that the decedent possessed which likely made his extubation, and airway management following extubation, more challenging if the decedent was not carefully evaluated and monitored at the time of extubation. The decedent was obese, which indicated that, upon extubation, he was likely to have shorter oxygen reserves and was more prone to desaturate quickly compared to a thin patient. Further, since the decedent had sustained a neck injury and was undergoing neck surgery he was more prone to develop airway restriction due to swelling in the operative area. The decedent also had hardware installed in his neck which likely reduced his range of motion and impeded the ability of the anesthesia team to manipulate his head during the emergency reintubation. Additionally, the surgery took approximately three hours, and during that time the decedent was in a prone position face down on the operating table for the three-hour period, which likely increased swelling about the decedent’s face and neck which likely impaired his ability to breathe upon extubation. Moreover, the decedent had facial hair which likely impeded the anesthesiologist’s ability to obtain an adequate seal between the decedent’s face and the ventilation mask when the emergency mask ventilation occurred. Lastly, the decedent had obstructive sleep apnea which increased the risk that his throat might close after extubation and impair his airway while he was under the effects of the anesthetic gases.

Plaintiff’s counsel also alleged that the anesthesia team failed to properly anticipate and prepare for “emergence agitation” which occurred during the decedent’s emergence from anesthesia and prior to extubation.  Emergence agitation is a well-known anesthetic phenomenon and can occur during emergence from anesthesia. Emergence agitation occurs where the patient emerging from anesthesia becomes physically agitated and violent. According to one of the anesthesia providers, as the decedent was being turned at the end of the operation from the prone position to the supine position, the decedent began to flail his arms and appeared to reach toward the endotracheal tube that was providing him oxygen. Fearing that the decedent would injure himself if he grabbed the ET tube, one of the anesthesia providers pulled the ET tube from the decedent’s throat which deprived the decedent of oxygen. Plaintiff’s counsel alleged that the anesthesia provider simply panicked and failed to consider other options, which included restraining the decedent or administering additional medication to sedate the decedent, which would have allowed the anesthesia provider the opportunity to maintain control of the decedent without removing the decedent’s ET tube.

Plaintiff’s counsel also alleged that the anesthesia team failed to monitor the decedent’s vital signs at the moment of extubation because the anesthesia providers removed the monitoring equipment from the decedent prior to removing his endotracheal tube.

Plaintiff’s counsel also alleged that the anesthesia providers failed to perform the appropriate anesthesia testing to determine if the decedent was ready to be extubated.

Lastly, plaintiff’s counsel asserted that the defendants failed to give the decedent, prior to the extubation, an adequate dose of Sugammadex to fully reverse the paralytic effects of the anesthesia gases given to the decedent during the surgery. The failure of the anesthesia team to administer the decedent an adequate dose of Sugammadex increased the decedent’s risk for respiratory compromise upon extubation because the full effect of the paralytic gases administered during the surgery likely remained in the decedent’s system and likely impaired his ability to breath spontaneously upon extubation.

The decedent’s beneficiaries included his wife and three minor children.

[19-T-036]

Type of action: Automobile collision; and anesthesia medical malpractice cases

Injuries alleged: Cervical fractures from the automobile collision; and hypoxic brain injury leading to death from the anesthesia medical malpractice

Tried before: Mediation

Name of judge or mediator: Hon. Michael C. Allen (Ret.)

Date resolved: January 2019

Verdict or settlement: Settlement

Amount: $2,000,000 ($100,000 in automobile coverage); ($1.9 million for the medical malpractice case)

Attorneys for plaintiff: William B. Kilduff and Thomas J. McNally, Richmond