A ‘beautiful’ six-year-old girl has died after a needle accidentally pierced a major artery during a ‘minor’ procedure.
In June 2022, Amelia ‘Millie’ Ridout tragically passed away at Addenbrookes Hospital due to severe internal bleeding. She had visited the renowned hospital in Cambridge for a suspected blood condition.
During the inquest, it was revealed that a paediatric doctor had noticed a red flag indicating a complication during a biopsy. However, a consultant haematologist did not express any concerns regarding the situation.
Despite the warning sign, the doctor was instructed to proceed with the procedure. Tragically, Amelia went into cardiac arrest shortly after, ultimately losing her life during emergency surgery aimed at correcting the bleeding issue.
Her father Matthew Ridout said he had felt suicidal after the fatal error but has since been raising money for the neo-natal intensive care unit at Luton and Dunstable Hospital which cared for Amelia when she was born prematurely.
And he ran the Three Peaks challenge on his daughter’s seventh birthday last May in a bid to be ‘close’ to her.
‘All I want to do is be as close to Amelia on her day, with being as high as I can in different locations seemed to be the only solution,’ he wrote on the appeal page.
Amelia Ridout, ‘Millie’, six, died after a needle accidentally hit her artery during a ‘minor’ procedure
She suffered ‘massive, catastrophic’ internal bleeding and died after she went to an NHS hospital with a suspected blood condition
The grieving father paid tribute to her on a JustGiving page where he has generously raised nearly £4,000 for the NHS despite the tragic accident.
He said: ‘Where do I begin…? What does a father say when he looses the one entirety that makes him whole? The one energy that were he would sacrifice all he has to give them a chance of being everything they can?
‘I lost my beautiful daughter Amelia ‘Millie’ tragically last year after a doctor pushed too deep during a BMA [bone marrow aspiration] last year, ending Amelia’s life instantly that day.
‘A day that will echo forever in my mind.
‘During Amelia’s short time in life she managed to touch/teach and express love to all she met, most of all her family and friends.
‘Although she did have a tendency to flaunt her sassy nature and have what I called creative play and life science lessons in the house and garden of our family house.
‘I myself almost meet the point of wanting to be with Amelia, but knowing the meaning of life Amelia taught me in her short time has helped me to focus on living life for the love of life.’
The father added Millie was born prematurely weighing just two pounds and four ounces.
She spent her first six weeks in the Luton and Dunstable Hospitals NIC unit before being released home on Fathers day – ‘the best gift ever!’
Elizabeth Gray, area coroner for Cambridgeshire and Peterborough, has called for national guidelines to be published for this type of procedure following the mistake.
The father added Millie was born prematurely and weighed just two pounds and four ounces. She died in June 2022
The inquest heard that the little girl had been diagnosed with pancytopenia, a condition where the body is not producing enough blood cells including red blood cells, white blood cells and platelets.
To explore the problem, she underwent a bone marrow biopsy, which the coroner called a ‘minor surgical procedure’.
A paediatric oncology specialist doctor carried out the bilateral bone marrow aspirate and trephine procedure, with the understanding that it was possible Amelia had cancer.
She was put under general anaesthetic for the procedure, which involves taking fluid and samples of bone marrow from hip bones.
When the doctor took out the hollow needle which had been used to take a sample of bone marrow they noticed a spurt of blood.
The coroner said: ‘Following the completion of the left sided bone marrow aspirate and trephine procedure the Paediatric Oncology Speciality Doctor carrying out the bone marrow aspirate and trephine procedure noted a spurt of blood on removal of the trephine needle and queried the sample extracted.
‘The supervising Consultant Haematologist was called in to review and confirmed that there was no signs to raise concern and that the bone marrow aspirate and trephine procedure should be concluded.’
Shortly afterwards, Amelia started to deteriorate and rapidly went into cardiac arrest.
Coroner Ms Gray said: ‘During the procedure, the trephine needle accidentally penetrated through the pelvic bone and pierced the iliac vessels causing massive, catastrophic bleeding internally.’
The paediatric resuscitation team attended promptly, and it was quickly established that Amelia was suffering an internal bleed because of the biopsy.
She was rushed into emergency surgery but ‘the bleeding could not be stopped’.
Elizabeth Gray, area coroner for Cambridgeshire and Peterborough, has called for national guidelines to be published for this type of procedure following the mistake
The coroner said: ‘Shortly after the start of Amelia Ridout’s surgery, she went into PEA [Pulseless Electrical Activity] arrest and needed chest compressions.
‘The surgical team continued to treat Amelia Ridout’s internal injury and identified a defect in the anterior arterial wall of the external iliac artery, the appearances of which were consistent with the anticipated needle injury caused by the bone marrow aspirate and trephine procedure.
‘Amelia Ridout’s condition continued to deteriorate despite continued resuscitation efforts.
‘The clinical team took the decision that continued efforts would be futile and Amelia Ridout was declared deceased.’
In a Prevention of Future Deaths Report, Ms Gray demanded the NHS produce guidelines to govern the procedure.
She wrote to the National Institute for Health and Care Excellence, the British Society for Haematology and NHS England.
She asked the organisations ‘To consider the development and publication of a national guidelines and standard operating procedure for the carrying out of Bone Marrow Aspirate (BMA) and trephine biopsy to include recommended methodology’.
The coroner also called for a database to be created to record bone marrow biopsy procedures and their outcomes.
The organisations must respond to the report by April 8.
A spokesperson for Cambridge University Hospitals Trust, which runs Addenbrookes, said: ‘The Trust is deeply saddened by Amelia’s death and our deepest sympathies and condolences remain with her family at this extremely difficult time.
‘The Trust continually reviews quality of care and treatment provided to patients and will, of course, reflect on the coroner’s findings with view to continuing to improve this care.’
