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 (389 Responses)
  1. janice

    Kudos to dr.C For your comments here. Extremely well put thank you.May God Bless the cmgresswoman her family and all of her medical staff

    January 11, 2011 at 14:20 | Report abuse | Reply
  2. Norman Einstein

    Good luck to Giffords in her recovery. Her future can still be bright – look at how Obama has made it through 49 years with half a brain and even got elected President.

    January 12, 2011 at 01:50 | Report abuse | Reply
  3. Jennifer Latif

    God Bless her family in this hard time.

    January 12, 2011 at 10:06 | Report abuse | Reply
  4. alexandra


    January 12, 2011 at 22:01 | Report abuse | Reply


    January 13, 2011 at 01:00 | Report abuse | Reply
  6. scott hitt

    I am sorry to hear of this, it is just absolutely terrible.. I hope that guy who did this, sufferers a very long, painful, brutal death... and I have to say a gun did not do this, a idiot with a gun did this, we need better gun laws, and maybe a physiological evaluation.. I'm truly sorry for this tragedy.. but justice and above all GOD will prevail.

    January 13, 2011 at 11:24 | Report abuse | Reply
  7. Judi Bennett

    Dr. Gupta do you know if Gaby knows & understands what happened at the shooting or would they purposely not go into it to prevent anxiety or emotional upset that would pit more stress on her. Also could someone from the mental health field explain what mental illness could cause Loughners violent spree. Could her pscyhiastrist reveal info & medications he's on that could have contributed to this spree.
    Also signs for family to look for with mental conditions. Thank you for all you do.

    January 13, 2011 at 12:24 | Report abuse | Reply
  8. Skippy

    As an Australian i speak and spell differently to those in the USA !

    14 wounded and 6 dead and the Funeral ceremonies about to start but in the interim some people are forgetting their priorities.
    To the families of all , the rest of the world are horrified to see the casualties and the grief imposed on their families through the actions of a person whose state of mind is in doubt. Rest assured there will be many following the progress of those hospitalised regardless of the privacy laws that currently prevent as much disclosure as is afforded regarding Gaby Gifford.

    On 23 Jan 2013 the world will see a new Presidential Inauguration and by then, one hopes that Gaby is recovered but more importantly that the People of the USA have become once again a United Nation rather than the fractious community that currently appears to exist. President Obama set the tone last night in Tucson but it is up to the community regardless of political persuasion to heed and practice his words.

    Does it require outsiders to remind Citizens of the USA of how lucky they are ? Try living in Haiti or Pakistan if you are in doubt.

    Health systems worldwide vary so it is not so unusual for treatment protocols to vary but i was impressed with the footage of helicopters landing into the supermarket parking area. I have been involved in helping them land on the ski piste and know the skill the pilots have to utilise. Find me on twitter as skippydetour or google parrabuddy.

    CONGRATULATIONS to those who disarmed the gunman, to those good samaratans who applied First Aid and to those responsible for the transport and hospital care, their professionalism appears to have minimised loss of life.

    PS hope the spelling and grammar has not offended any !

    January 13, 2011 at 15:32 | Report abuse | Reply
  9. paul parsons

    i am sure that there are several dozen remote healers around the country contributing to her recovery

    January 14, 2011 at 13:33 | Report abuse | Reply
  10. andrew kurtz

    God made humans with free will. they may freely choose to do whatever they want. however there are consequences for the choices we make. God likely does not know the future actions of people because if he did that would be a violation of free will. God's part in the tragedy is healing to the hearts of those involved regardless of the physical outcome. God's part is also judgement of the one freely choosing to commit the tragedy or extending mercy to the perpetrator if the perpetrator freely chooses to accept mercy from the One who has offered, go and sin no more.

    January 14, 2011 at 18:49 | Report abuse | Reply
  11. pqTINA PAUL

    Our thoughts and prayers are with you and your family at this time.

    January 15, 2011 at 16:38 | Report abuse | Reply
  12. mikee

    May jarred loughner burn in hell...

    January 16, 2011 at 07:18 | Report abuse | Reply
  13. Jill

    Hope she has a full recovery!

    January 16, 2011 at 08:18 | Report abuse | Reply
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  16. William Schwartz

    Does anybody know if the congresswomen is right handed or left handed. In righties, language is in the left brain. In lefties, it tends to be shared by both hemispheres of the brain, (Advantage Lefties!). If the congresswomen is a lefty, there's a far better chance she'll recover speech. Dr. Gupta – Are you there?

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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.