A toddler with charge syndrome died after his tracheotomy tube came out, leaving him unable to breathe and consequently brain dead, an inquest heard.
Archie Hames, three, of the Roundway, Claygate, died at Shooting Star Chase Hospice in Hampton days after he was found in cardiac arrest in his cot on January 15, 2012.
His parents found him at 7am without his tracheotomy tube, which had been secured with Velcro straps, and not breathing. Paramedics battled to resuscitate him and did, but he was left with permanent brain damage.
In a statement, Jayne Turner, Archie’s grandmother, said after hearing what had happened, she rushed to the family home which she described as “bedlam”.
Ms Turner said: “A paramedic came out of the bedroom and said he was resuscitated but didn’t think he would make the journey [to hospital].”
After being resuscitated and taken to Kingston Hospital, Ms Turner cleared up medical paraphernalia in her grandson’s bedroom, when she noticed the tracheotomy tube had come out in his cot and was broken.
Archie, who was also fed through a gastrostomy, relied on the bespoke Arcadia brand tracheotomy tube to breathe, but his parents had previously complained to the company that some had split.
An independent investigation carried out by Gavin Hughes from SMTL, on behalf of the coroner, found when Velcro was used to secure the tracheotomy, wear occurred on the sides from between five to 28 rethreads, which would occur after the tracheotomy tube had been cleaned daily.
A post-mortem examination concluded Archie died from to cerebral hypoxia, airway obstruction and charge syndrome.
Recording a narrative verdict, Martin Fleming said: “He was very well looked after by his parents and up until this incident, was doing very well.
“It is more likely than not his tracheotomy device became dislodged, leading to oxygen starvation and his death.”