May 5th, 2011
12:49 PM ET
Don’t miss “Dr. Sanjay Gupta Reports: Saving Gabby Giffords,” on Sunday, May 8 at 7 p.m. ET. The documentary reveals exclusive details of the extraordinary efforts by paramedics and doctors credited with saving the life of the congresswoman. You can also join Dr. Gupta for a LIVE chat on Twitter during the program.
While traveling around the country the last few months working on an upcoming documentary about Congresswoman Gabby Giffords, people would often stop me and ask questions. “How exactly did she survive?” was a common one. “Will she return to Congress?” was another. One woman stopped me at an airport by gently grabbing my forearm. “Gabby - isn’t it a miracle," she stated, more than asked
As a neurosurgeon, I have taken care of many patients with gunshot wounds to the head. If you look at national statistics, only around 5 to 10% survive
From the moment Giffords was shot, the odds were stacked against her. So, how did she survive? I want to take you through the critical analysis that takes place in the trauma team’s minds.
According to a recent article in the Journal of Trauma, there are three things that are most important when predicting survival in a patient like Giffords.
First of all, was her blood pressure stable when she arrived at the hospital? According to her paramedics, Aaron Rogers and Colt Jackson, who cared for her within minutes of the shooting, Giffords' blood pressure did not drop, and there wasn’t continued significant bleeding. They told me they were able to place large IV lines in Giffords’ veins, and replace fluids while she was being transported to the hospital. Having enough fluids and a normal blood pressure means her traumatized brain was not simultaneously being deprived of oxygen.
Second, were Giffords' pupils reactive to light? You have likely seen doctors shining a light into a trauma patient’s eyes. Normally, your pupils shrink in response to a bright light, and dilate in darkness. That is why you squint when walking out into a bright day, until your pupils accommodate. If a patient has significant brain swelling, one of the early consequences is pressure on the nerve that controls your pupils. In that case, the patient’s pupils will not constrict in response to a bright light. Gabby Giffords had a badly swollen right eye, so it was difficult to examine. Her left pupil though, responded normally.
Another factor is something known as the Glasgow Coma Scale or GCS.
This is an important neurological exam that can be performed in less than a minute, in the field. It takes into account, motor movements, verbal capabilities and eye opening. A normal score is 15, and score of 3 is the worst. Anything above a score of 8 is favorable for survival. Take a look at the chart at the link above; Giffords scored around a 10. She was following motor commands, such as squeezing a hand or raising two fingers. 6 points for that. She wasn’t opening her eyes, so only 1 point there. She was, however, making grunting noises or incomprehensible words, and that was another 3 or 4 points.
There are a few other things Giffords doctors immediately noted when she arrived at the hospital. The gunshot wound was “through and through.” That can be a positive sign for two reasons. A relatively small exit wound means the bullet likely didn’t tumble significantly, nor “explode” in the brain. Also, if you consider a bullet has a finite amount of energy, you would like more of that energy to be dissipated into space, rather than inside the skull.
Even more importantly, the injury to Giffords was only on one side of her brain. Trauma neurosurgeons will always be quick to point out: A bullet that crosses the midline of the brain (left to right or vice versa) is a much worse injury.
Dr. Michael Lemole, the neurosurgeon who cared for Giffords, also made a critically important decision. He realized that although Giffords had not yet shown signs of brain swelling, it was inevitable given her injury. The brain, unlike other organs in the body, has no place to swell, given the rigid casing of the skull. So, Lemole addressed that problem by removing the left half of Gabby Giffords' skull, and leaving it off. In the world of neurosurgery, it is a commonly performed procedure and to some degree is an example of medical lessons learned on the battlefields.
Of course, everything I just described gives you some real background on what helped Congresswoman Giffords survive. The other question, though: Can she return to Congress? Difficult to know at this point, but tomorrow, I will take you inside TIRR Memorial Hermann rehab hospital to try to give you an answer.
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.