Dawn Sturgess’s chances of survival are said to have been “vanishingly small” after almost 10 minutes passed following her cardiac arrest.
The inquiry heard on Wednesday that the cause of Ms Sturgess’s death was a hypoxic-ischaemic brain injury as a result of cardio-respiratory arrest caused by nerve agent poisoning.
Hypoxia in the brain is caused by a lack of oxygen and ischaemia by a lack of blood flow.
Dr Jasmeet Soar, who works in intensive care medicine and is a consultant at Bristol’s Southmead Hospital, explained that the effects of Novichok, if not treated “rapidly”, can lead to a “vicious circle of the muscles getting weaker” including muscles in the chest and diaphragm which are the mechanisms by which we breathe.
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He said failing to breathe leads to falling blood and brain oxygen levels which can result in unconsciousness and eventually in the heart stopping beating.
Once the heart stops beating, the brain is starved of oxygen and is “dying very slowly”, the doctor continued.
Mr Rowley found his girlfriend in the bath with no water and described her as being “unresponsive, looking unwell and having seizures or breathing difficulty”, Dr Soar said, making reference to Mr Rowley’s interviews heard earlier in the inquiry.
Mr Rowley called an ambulance at 10.14am, and Dr Soar explained how in the background of the call, you could hear Ms Sturgess' breathing slowing until 10.20am when it stopped.
Dr Soar said: “We know in Dawn Sturgess’s case Charlie Rowley did some chest compressions but we don’t know how many and how effective they were, they may have got a little bit of blood flow."
Dr Soar estimated that Ms Sturgess’s brain was deprived of oxygen for between 31-37 minutes by the time her heartbeat was restored.
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The consultant quoted figures saying the survival rate for people treated by English ambulance services in 2018 who had cardiac arrests and had the same heart rhythm seen in Ms Sturgess’s case was 1.6 per cent.
He said Ms Sturgess’s chances would be “significantly less” than that 1.6 per cent, saying the figure included people who had “primary” cardiac arrests – rather than “secondary” ones that came about as a result of respiratory arrest – and people who became unwell in public places where more bystanders could help.
Dr Soar went through the three brain scans that Ms Sturgess received once in hospital which showed she had a “global” injury to her brain, meaning an injury that affects her whole brain.
He said the first scan showed subtle signs of hypoxic-ischaemic brain injury but the second and third identified a “devastating brain injury”.
His opinion after the second scan, performed on July 6, was that “there was no possibility of Dawn Sturgess surviving”.
Dr Soar explained Ms Sturgess was likely the only victim of the poisonings who had a cardiac arrest because she was probably exposed to a relatively large dose of Novichok compared to Mr Rowley and the Skripals, where she allegedly sprayed it on her wrists rather than just touching it accidentally.
He also said she likely would have inhaled aerosol components of the agent.
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