Further concerns have been raised over the use of external ventricular drains (EVD) in the time leading up to a man’s death at Salford Royal Hospital.

Firth Lord, of Martin Street, Turton Bottoms, died on December 18, 2019, after initially attending hospital with hydrocephalus, or water on the brain, on November 27.

He suffered a cardiac arrest around 9am on November 28 which was likely to have caused ‘catastrophic brain injury’, said intensive care consultant Dr Timothy Fudge, which he never recovered from.

Bolton Coroner’s Court heard evidence from various nurses at Salford Royal who treated Firth in the early hours of November 28. This was after he underwent emergency surgery for the hydrocephalus, which was causing him severe headaches and nauseousness, having an EVD fitted to drain fluid and release pressure from his brain.

Around 4.15am, Firth was taken into a recovery area at the hospital where he was treated by nurses Janet Jones and Roy Chavez, both of whom had extensive experience treating patients with an EVD fitted.

Both nurses gave evidence to say they kept a regular check on the EVD and the two ‘valves’ on it. The valves were kept open to drain fluid from the brain with the amount of fluid regularly checked.

The valves were only closed when they needed to move Firth, which included transferring him from the trolley from surgery to a bed. Nurses Jones and Chavez said the valves were checked regularly and opened after transferring him onto the bed, and were open just before he was transferred from the recovery area to a ward.

Around 5.45am he was transferred to Marnie Shirtcliffe, a registered nurse on ward B7. She said fluid kept draining at first but between 6am and 7am there had been very little draining but this was “not a concern”. At this point Firth was handed over to day-shift nurses.

Firth came under the care of Laura Tolley and then Amy Coles who explained that, despite fluid not draining from the EVD, Firth’s observations were okay and there was no suggestion the EVD still wasn’t working as it was ‘oscillating’.

Mrs Coles said that Firth was responsive around 8pm and not a cause for concern.

Firth had become slightly agitated after being sat-up for medication and breakfast, which is expected after an operation, with a care support worker and health care assistant there to make sure he did not remove tubes or get out of the bed.

Emma Littlewood, a health care assistant who stayed with him, said: “He was very restless and agitated. I was holding his hand reassuring him about where he was and that he was okay.”

He managed to sleep after being administered medication to help with his pain. But Ms Littlewood then noticed around 9am he was unresponsive and she alerted colleagues and sounded a ‘crash alarm’.

CPR was started on Firth, with Martin Palin, a neuro-surgical registrar attending and noticing one of the EVD valves was clamped, meaning no fluid could drain.

Mr Palin drained a substantial amount of fluid which helped the resuscitation of Firth to the point he could be put on a ventilator and transferred to intensive care.

Mrs Coles recalled being asked by Mr Palin why this valve was clamped, but could not answer why as she and Ms Tolley both said that they were told to never check this valve, and had no reason to believe it had been clamped at any point as the EVD was still ‘oscillating’.

In the days after the cardiac arrest Firth’s condition deteriorated with Dr Joshi George, a consultant neurosurgeon saying this deterioration may have been due to “devastating irreversible brain injury” as a result of the cardiac arrest. A CT scan on December 3 showing ‘severe brain injury’ confirmed this.

Brain scans in intensive care showed a lack of activity in Firth’s brain stem and also signs of ongoing lymphoma. After more deterioration Firth’s death was confirmed on the morning of December 18.

The family, represented by lawyer Paul Williams, is raising concerns if the lymphoma had been definitively diagnosed earlier, different treatment could have been done which could have prevented the eventual hydrocephalus and the need for the EVDs, and the complications with this that led to the cardiac arrest.

The inquest continues.