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Biomedical Research

Asphyxiation and Westaby Tubing

Exploring the causes and effects of asphyxiation and how the cardiothoracic surgeon, Professor Stephen Westaby, revolutionised treatment.

By Sophie Farr

Published 5:49 PM EST, Sun March 7, 2021

Introduction

The world renowned cardiothoracic surgeon, Professor Stephen Westaby, details tragic cases of asphyxiation during his career in his memoir, “Fragile Lives,” and his innovation, which revolutionised treatment. Asphyxia is a broad term which refers to when the body does not have sufficient oxygen, resulting in unconsciousness and  suffocation. Although they may all result in asphyxia, there are a plethora of different causes of the critical state which include choking, severe burns, seizures, carbon monoxide poisoning and contact with other harmful chemicals. This allows the condition to be separated into two causes: physical or chemical asphyxia. This article will focus on physical asphyxia but also touch on carbon monoxide poisoning as the most common cause of chemical asphyxia. 

Physical Asphyxiation

Physical asphyxia is typically due to obstruction or mechanical force which prevents your cells from receiving sufficient oxygen through breathing. For example, choking is an obstruction which results in asphyxiation due to it preventing you from taking deep enough breaths to supply the body with adequate oxygen levels. In cases such as these, as well as similar causes such as aspiration which is where food or water travels down an incorrect pipe, treatment is urgently required to remove the blockage. Many people will be familiar with the Heimlich maneuver and abdominal thrusts to resolve choking and CPR. Furthermore, mouth to mouth resuscitation is also commonly used to save the victims of drowning (a type of aspiration). But what happens when parts of your own body are causing this fatal obstruction?

Seizures are another more common cause of physical asphyxiation due to epileptic seizures sometimes causing apnea or a sudden break from breathing. If this occurs, oxygen saturation can plummet to fatal levels and require immediate treatment. Epileptic seizures can also cause asphyxia through force as the airway can occasionally become obstructed by objects such as pillows when convulsing. 

As Professor Stephen Westaby narrates in his book, many cases of asphyxia are the result of trauma such as severe burns. He tells the harrowing story of a young boy Cape Town, Olim, who had been the victim of an explosion in his house, inhaling toxic gases,  likely due to a stove or gas cooker. In cases such as this, the body’s own process of recovery, through inflammation of the affected tissue and scabbing to allow healing, can cause asphyxiation. These patients are likely to already be in critical conditions, unable to breath unsupported by a tracheostomy: a surgery where incisions are made in the trachea to allow air to be ventilated through tubing through the neck. However, treatment such as this can be dangerous due to the risk of infection around the exposed tubing and not always accessible, especially in crisis hospitals where this young boy was treated. 

Westaby Tubing

Professor Westaby was personally affected by the traumatic complications as his own grandmother had experienced asphyxiation in the final weeks of her struggle against thyroid cancer. This connection to the horror patients’ experience inspired him to not only become a doctor due to wanting to prevent other people suffering through that level of pain and fear, but also made him determined to treat the young boy. Having previously treated a construction worker, Mario, who had suffered extensive burns in an accident, Westaby had made great scientific progress by pioneering a new technique for asphyxiation. He employed the help of a company which produced medical tubing and requested them to produce a Y-shaped piece which could be fed down the bronchi, through the damaged tissue, until it reaches a healthy lung to aid breathing and relieve asphyxiation. This procedure, although novel and potentially risky, alleviated the patient’s suffering and allowed for easier management of an otherwise horrifically painful illness. Westaby received the honor of having the new medical tubing named after him and it is now branded as “Westaby Y-Tubing”.

Despite being presented with an even more complex case, due to it being on a child who was malnourished and had a significantly smaller respiratory system, Westaby adapted his treatment to a child’s body. His adaptability and confidence are key skills any doctor requires; although there were risks to the surgery, Olim’s injuries were likely to be fatal therefore it was worth attempting treatment to improve his quality of life. The operation was successful but, tragically, Olim passed away a year and a half later with no obvious cause. 

Chemical Asphyxiation

The most common cause of chemical asphyxiation is carbon monoxide poisoning. The colourless, odourless, toxic gas binds with haemoglobin in red blood cells to form carboxyhemoglobin. This results in a reduced capacity for the red blood cells to carry oxygen and, in turn, the effects of asphyxia due to insufficient oxygen levels. Therefore, the symptoms of carbon monoxide poisoning, such as fainting, are the same as the broader disease. In order to prevent poisoning, house owners should purchase a CO monitor to detect the gas in case of emergency.

Although asphyxia has a multitude of different causes, professionals such as Professor Stephen Westaby offer us hope that medical advancements are offering innovative advancements as time progresses. His career acts as an example for aspiring doctors who can learn from these transferable skills of problem solving, pragmatic thinking, and creativity.

Sophie Farr, Youth Medical Journal 2021

References

“What is Asphyxia?” Web MD, Accessed February 2021 from: https://www.webmd.com/first-aid/asphyxia-overview#1 

“Fragile Lives” Professor Stephen Westaby

“Asphyxiation” Medical News Today, Louise Morales-Brown, September 2020; Accessed February 2021 from: https://www.medicalnewstoday.com/articles/asphyxiation 

Geevasinga, Nimeshan et al. “Choking, asphyxiation and the insular seizure.” Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia vol. 21,4 (2014): 688-9. doi:10.1016/j.jocn.2013.05.012 

By Sophie Farr

I am a student from the UK and my ambition is to become a doctor.

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