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January 10th, 2011
06:25 AM ET

Gupta: What helped Giffords survive brain shot

CNN's Chief Medical Correspondent Dr. Sanjay Gupta is a practicing trauma neurosurgeon and associate chief of neurosurgery at Grady Memorial Hospital in Atlanta.

Rep. Gabrielle Giffords is in critical condition on a ventilator after being shot through the back of the left side of her head, yet doctors are “cautiously optimistic” about her survival. That she is alive at all is surprising to many people, but people survive these types of injuries more often than you may think.

While every patient and injury is different, on average – around 2/3 of patients with a gunshot wound (GSW) to the head don’t live long enough to make it to the hospital. Of the third that do make it, only 50% of those patients survive longer than 30 days. And of course, those numbers say nothing of long-term neurological function in the survivors.

So far, according to her doctors, Giffords is likely to be in the small minority of patients who will beat the odds. So, what placed those odds in her favor?

First off, she received very quick care, and was in the operating room within 38 minutes after arriving at the hospital. Her overall health and youth also provide some benefit. The injury was a “through and through” injury, meaning there was both an entry and exit wound. That’s significant because some of the energy of the bullet was dissipated into space, as opposed to all within her cranial cavity.

Neurosurgeons will want to know if the bullet passed across the midline of the brain. If it does, there is a much poorer likelihood of survival. In Giffords' case, it did not. Other positive factors: Her blood pressure didn't drop as a result of the bleeding, and the oxygen supply in her body was maintained, according to her doctors that I interviewed.

Finally, the fact Giffords was “following commands” even before she had an operation was a very positive sign.

To follow commands signifies a higher level of brain function than simple reflexive movement. It indicates that she was able to hear the command. She was able to process the meaning of that command, and finally, she was able to execute the command. I spoke to Dr. Randall Friese, the trauma surgeon who examined Giffords when she arrived at the hospital. He told me she was clearly able to understand him, and squeezed his hand when asked to do so. And, after the operation, Giffords was still able to follow commands.

During an operation like this, doctors want to control bleeding, remove fragments of bone that have penetrated the brain, and remove any dead brain tissue along the trajectory of the bullet.

Also, her neurosurgeon, Dr. Michael Lemole, removed additional bone on the left side of her head, as I explain in the video above.  That is called a craniectomy, and is done to prevent the catastrophic consequences of brain swelling, which is a big and real concern over the next several days. Think of it like this: Unlike organs in others parts of your body, if the brain swells, it has no place to expand - as it is confined by the rigid skull. Because Lemole removed portions of the skull, he provided extra room for the brain to swell. Incidentally, the bone that’s removed is saved, and put back in the head during a future operation.

In medicine and surgery, doctors are reluctant to quote statistics, because every patient is a true individual –that includes Gabrielle Giffords. And, no doubt, Giffords is not “out of the woods” yet. But, “cautiously optimistic” sounds pretty good after an injury as devastating as this one.



soundoff (324 Responses)
  1. SCRUMB

    Test

    January 10, 2011 at 15:48 | Report abuse | Reply
  2. Dempsy

    I am at a complete loss, the misspelled word only exist in your response. And as other posters have suggested, even if it were, to complain and critique on it shows that your are not looking at the meaning of what is trying to be conveyed.

    January 10, 2011 at 15:57 | Report abuse | Reply
  3. GetReal

    Obviously, they edited the article later on. It does irk me as well when I see errors like that, as spellcheck is readily available for obvious errors. Whatever. Surviving a through and through headshot is pretty unbelievable. Hope she continues to improve.

    January 10, 2011 at 16:15 | Report abuse | Reply
  4. John Allen

    a non-hollow point bullet allow the energy to leave with most of its energy in tact was a major factor – hollow points do the exact opposite – i agree with the Arizona Sheriff; guns and ammo do not belong in everyone's hands...

    January 10, 2011 at 16:15 | Report abuse | Reply
  5. billups

    Wake up ppl.our society caughtup with selfish pleasures.have u ever hunted with a pistol?think ppl

    January 10, 2011 at 16:15 | Report abuse | Reply
  6. jackson

    First and foremost, my prayers go out to all involved in this tragedy. May the criminal who did this get his justice. But folks, this blaming it on the media, Ms. Palin, or the man-in-the-moon is just crazy. Sure we have our 'differences', but no sane person of any politcal agenda would espouse such violence in any terms. Banning all guns would do nothing either; then only the criminals would have guns. We, as a nation of one people, need to turn down the rhetoric and simply pray for the recovery of the survivors, and for the family and loved ones of the fallen. Let's get real about this, whether you can spell or not!

    January 10, 2011 at 16:17 | Report abuse | Reply
    • chris

      About how President Lincoln's survival would have affected history: From my reading on the Civil War, including the book Team of Rivals, It is my understanding that the administration would have been kinder to the South. More willing to bind up the nation's wounds rather than punish the Confederates. IMHO>

      January 10, 2011 at 23:30 | Report abuse |
  7. looking_at_you

    Let us all keep our eye on the ball; less we get distracted and another attack will take place and we will not be prepared because we did not pay attention to the critical details. We all mis-spell sometimes in this high-tech world, however we all ndde to use some logic when trying to interpret & understand what we are reading and talking about!

    Here's Looking At You!

    January 10, 2011 at 16:32 | Report abuse | Reply
  8. john

    Question for Dr. Gupta: given the same quick response time and today's medical technology, would Lincoln have survived his gun-shot wound? Just wondering how our country might be a better place if Lincoln had survived???

    January 10, 2011 at 16:49 | Report abuse | Reply
  9. AN

    Dude,

    Must you interject on everything that happens in the world?

    AN

    January 10, 2011 at 17:01 | Report abuse | Reply
  10. MGoBlue

    Sanjay back to his neurosurgery roots!

    January 10, 2011 at 17:03 | Report abuse | Reply
  11. MGoBlue

    sanjay back to his neurosurgery roots! Not many GSW's to the head in ann arbor though

    January 10, 2011 at 17:04 | Report abuse | Reply
  12. terri

    Penelope.......What the he11 is wrong with you???

    January 10, 2011 at 17:25 | Report abuse | Reply
  13. Bro

    Peace!!!!! He is not a ESL teacher for crying out loud!!!

    January 10, 2011 at 17:56 | Report abuse | Reply
  14. BilL

    Why do people think they are smarter because they picked up a misspeLed word.
    Say some thing nice It wilL not hurt. BilL from c.t speedy recovery

    January 10, 2011 at 18:01 | Report abuse | Reply
  15. stk5357

    I don't get it...how come shewas shot in the back of the head? I thought this guy was in the audience?

    January 10, 2011 at 18:02 | Report abuse | Reply
  16. BilL

    And I misspeLLed this word bilL

    January 10, 2011 at 18:05 | Report abuse | Reply
  17. Sandra

    Yanno, instead of all you wonderful people being Conan The Grammarian, or Online Spell Checkers/Critics, how about you just wish Rep Gabrielle Giffords well and a speedy recovery? Or can't you hang up your political spin that long?

    To Rep Giffords, here's hoping for the best possible outcome.

    January 10, 2011 at 18:23 | Report abuse | Reply
  18. Oodoodanoo

    We'll match our Democratic women against your Republican men any day of the week.

    January 10, 2011 at 18:33 | Report abuse | Reply
  19. MooMoo456

    Why is NO ONE talking about this connection????? Loughner went to a Bill Ayres sponsored high school. Gee I wonder why.....hmmmmmmmmmmmm......could it be that Michelle still hates her country????

    http://www.usmessageboard.com/conspiracy-theories/149918-obama-to-ayers-to-klonsky-to-loughner.html

    January 10, 2011 at 18:42 | Report abuse | Reply
  20. Jeremy

    Would the full introduction of ObamaCare have lowered her changes for survival?

    January 10, 2011 at 19:04 | Report abuse | Reply
  21. mntest347

    To summarize – Rep Giffords survived the gunshot wound because it was not fatal.

    Thank you, Dr. Gupta.

    January 10, 2011 at 19:04 | Report abuse | Reply
  22. john la rue

    98% of the guns police in Mexico confiscate from gang/drug killings originate here. The guns are next to impossible to get in Mexico because they have tough gun laws so they are smuggled in from the US. We blame the violence on Mexico but are we not partly to blame? Let's visit our northern neighbor. Canada's cities have much lower death rates from guns compared to similar sized cities in the US. Let the "LOCK AND LOAD/CROSSHAIRS" words change to get the buggars at the poles as they most certainly are as I type this missive to you and be glad we may not have the best health system but we certainly may have the best emergency health system in the world. Mental health is too often ignored, and left up to you guessed it the overworked emergency healthcare system that is ill-prepared to deal with crises in mental health. So easier and even early manditory mental health intervention combined with more sensible and careful

    January 10, 2011 at 19:22 | Report abuse | Reply
  23. Brian

    Gupta is an expert at happy talk; that's why CNN uses him. If she survives she will be severely disabled with multiple handicaps.

    January 10, 2011 at 19:56 | Report abuse | Reply
  24. bill

    olny iotids winhe aobut slepl cechk.

    January 10, 2011 at 19:56 | Report abuse | Reply
  25. Dr. Gupta

    Please people enough about spelling and politics. More about me, me, me!

    January 10, 2011 at 20:01 | Report abuse | Reply
  26. mina

    America needs more schools and assylums and rehabs for their citizens. Even in crisis they can't decipher good from bad and complain on spelling. How ignorant and insensitive. Don't people practice christianity. Some of u need to come to our side of the world to learn and grow up. Great learning article and very enlightening. Really thought some americans would grow up after 911 but it has put them in stoneage. Very sad, spell check, get real and get a life!!!

    January 10, 2011 at 20:34 | Report abuse | Reply
  27. mina

    I follow prolife on facebook and they posted numerous items today indicating that the congresswoman votes against life and supports abortion so let her fight for her life. I actually thought these were god fearing people hosting this face book page and they refused after several request to remove the post. Another typical example of the hypocitical americans who are pro life only for unborn babies and not for other situations. Mark you, I'm for life and against abortion but shocked and embarrased that pro life would post these distasteful comments on the lady after such a tragedy

    January 10, 2011 at 20:38 | Report abuse | Reply
  28. Hey Penelope

    Gupta's a respected neurosurgeon. What you think of his credibility hardly matters.

    January 10, 2011 at 21:12 | Report abuse | Reply
    • Penelope

      Just so you know I was not talking about the credibility of Dr. Gupta. I was talking about the editors of CNN health. Just to clarify.

      January 10, 2011 at 22:46 | Report abuse |
  29. Frank

    I'm ready to give up my rights to guns, and free speech, and EVERYTHING, and be a slave to the banks! Huh? How about you, fools?

    January 10, 2011 at 21:15 | Report abuse | Reply
  30. Bonnie

    Great article and my prayers go out to all involved in this tragedy...this country needs more prayer and belief in God....

    January 10, 2011 at 21:27 | Report abuse | Reply
  31. jeremiah

    I wish her a full recovery! And thank you to the professionals that got her to the hospital so fast!

    January 10, 2011 at 21:48 | Report abuse | Reply
  32. jake

    Thanks Palin !!

    January 10, 2011 at 22:22 | Report abuse | Reply
  33. jake

    You can all thank Sarah Palin for the violence, and her anti-patriotism !!

    January 10, 2011 at 22:24 | Report abuse | Reply
  34. Chris M

    stk5357

    I don't get it...how come shewas shot in the back of the head? I thought this guy was in the audience
    -----------------–
    She wasn't shot in the back of the head- the bullet exited the back of her had.

    January 10, 2011 at 22:49 | Report abuse | Reply
  35. Neil n Kansas

    Tough gal she is.....Prayer changes things...

    January 10, 2011 at 22:52 | Report abuse | Reply
  36. Jack Howitzer

    she is awesome, obviously stronger than the dead guy who pulled the trigger. he scares me, and I don't get scared of anybody.
    h††p://unitwan.co.nr

    January 10, 2011 at 23:00 | Report abuse | Reply
  37. jerseygirl

    I wish Sanjay had told people that contrary to what we heard, you do not apply pressure to a head wound where there is skull damage. You don't want to press broken pieces of skull into the brain. People do it instinctively but it's wrong, unless it is a more superficial wound and then you wan tto do it lightly becuase scalp inuries are painful.

    January 11, 2011 at 00:37 | Report abuse | Reply
  38. Sanjay G.

    To little cu!\!ts like Lucas and Penelope,
    Stop reading my work. You are too stupid to begin with. I hope someone puts a bullet in your brains and you don't SUVIVE.
    -Sanjay

    January 11, 2011 at 00:55 | Report abuse | Reply
  39. Compassion

    Oh yeah Jake. Palin and Bush all the way. Shame on you to hell. God Bless Rep. Giffords and all mothers surivors.

    January 11, 2011 at 01:05 | Report abuse | Reply
  40. Eddie Bailey

    Bush,palin,hannity,limbaugh,rowe,and a terribly long list of subversive radical hate mongers.does anybody remember the 60's.peace,love and brotherhood are DEAD!

    January 11, 2011 at 01:17 | Report abuse | Reply
  41. Elio vianna

    Giff for Governor! (Az).

    January 11, 2011 at 01:23 | Report abuse | Reply
  42. forget spelling

    I'm more annoyed that they bother to mention an acronym – gunshot wound (gsw), then never use the acronym again in the article. Why define it if you're not going to use it?

    January 11, 2011 at 01:30 | Report abuse | Reply
  43. Tas

    Question for Dr. Sanjay Gupta: Even though it seems she can listen, process and execute, aren't there possibilities that she might have lost other motor skills? or may be other biochemical functions since the bullet has passed through the brain tissues?

    January 11, 2011 at 02:25 | Report abuse | Reply
  44. mike

    "Neurosurgeons will want to know if the bullet passed across the midline of the brain. If it does, there is a much poorer likelihood of survival." I wish he'd gone into more detail about that. I remember the doc at the new conference making that point but I don't know the physiology involved.

    January 11, 2011 at 03:00 | Report abuse | Reply
  45. cari

    On-scene triage by paramedics takes many factors into consideration. One of the most significant in this case is that the 9 year old girl was most likely dead when they arrived on-scene, and the congresswoman was alive. Medics don't treat dead people because it is a waste of time. And they give NO preference to status, be it a congresswoman, Joe the butcher or a bum. And praise to the intern who reacted immediately to attempt to maintain homeostasis. His actions should be commended, but he is far from a "hero". That word is thrown around too casually. A hero sacrifices his or her life for that of another, and to use it to describe anyone else is an slap insult to those who have made the "ultimate sacrifice". There is only one kind of hero-a DEAD hero. The intern's actions were probably life-saving for her, but they should be kept in perspective-he only did what he knew was proper protocol in that situation. Also the congresswoman is strong SUPPORTER of an American citizen's RIGHT TO BEAR ARMS!!!

    January 11, 2011 at 03:06 | Report abuse | Reply
  46. Sara

    My prayers to all. Thank goodness for such great doctors. Not to mention Daniel.

    January 11, 2011 at 09:53 | Report abuse | Reply
  47. Sara

    Lets not worry about spelling. It happens and the world will not fall apart. Let's just send well wishes to all.

    January 11, 2011 at 09:58 | Report abuse | Reply
  48. Curlysue

    Wot really ah-mazes me is duh fact that over fort- teen farm-ma- lees lifes are flipped upside down and people trip-pin over spell- lyns and gram-mas!

    January 11, 2011 at 10:10 | Report abuse | Reply
  49. Drin King Water

    According to the story: "First off, she received very quick care, and was in the operating room within 38 minutes after arriving at the hospital." Luck her that she doesn't have to deal with the same health insurance HMO issues the rest of us have to deal with. Otherwise by the time the paperwork and authorizations for surgery had gone through her body bag would have been ready to go.

    January 11, 2011 at 11:49 | Report abuse | Reply
  50. shorty

    Why does everyone always want to talk about the rich people. why dont we talk about people who are poor and have been shot

    January 11, 2011 at 12:30 | Report abuse | Reply
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About this blog

Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.