How Johns Hopkins saved an infant with a '1-in-a-million' shot at survival

'It was like a 1-in-a-million shot' that the infant did not die, surgeon says

Editor's note: This story was updated on May 3, 2019.

In summer 2016, Johns Hopkins Hospital's trauma team got the heartbreaking word: A pregnant woman was shot in the abdomen—and she's headed your way, Tim Prudente reports for The Baltimore Sun.

Around midnight on June 19, Vanessa Sims was walking toward a local restaurant to pick up an order of fried rice. At eight months pregnant, it's what she craved.

Without warning, shots rang out. Someone shouted, "'It's coming from behind the wall,'" and as Sims attempted to run for safety a "stray bullet tore through [her] swollen belly," Prudente writes.

Kent Stevens, who was running the trauma service at Hopkins that night, got a page as the ambulance was in route. It read "Delta," the most urgent call. Next, Stevens gathered his team of residents, obstetricians, anesthesiologists, and CT scan technicians.

Sims arrives

When the ambulance arrived, at 12:23 a.m., Sims could say her name—which meant she was breathing—but her pulse was accelerated, and her systolic blood pressure was slightly low. The bullet had entered her lower back, and doctors were concerned she might be paralyzed because she had a fractured spine. Luckily, while her left foot was numb, she could move it, Purdente writes.

Stevens teaches his residents to count bullet holes to see if rounds are still trapped inside the body (odd numbers indicate that there are). There was one wound in her belly and another wound in her back. So there was no bullet trapped inside—but the round appeared to have passed directly through the womb.

Stevens needed to move quickly. He wrestled with whether to order a CT scan. "A scan would take three or four precious minutes," Purdente writes. Stevens made the call, opting for a scan of the lungs, liver, spleen, and stomach. It found there was blood in Sims' uterus.

The OR was being prepped as Stevens called ahead. "I'm coming now," he said.

Into the OR

After Sims was "medically paralyzed," Prudente writes, doctors cut down the middle of her belly. "The boy was turned head-down for birth, and doctors lifted him out."

The boy was six weeks premature and should have cried—but was silent, Prudente says. Doctors worked feverishly to save his life. The bullet had shattered the infant's collarbone and physicians worried it may have damaged his subclavian artery. As blood was lost, the risk of cardiac arrest increased dramatically.

"The Hopkins surgeons only knew of similar instances" of a fetus being shot in the womb "through years-old case studies," Prudente writes. "But they knew they didn't have much time." They needed to stop the bleeding.

They inserted a breathing tube, and set up an IV to deliver adrenaline that strengthened his heart—but then his heart "crashed," Prudente writes. Doctors started chest compressions and nurses held pressure to the infant's wounds to stop the bleeding.

Dylan Stewart, the pediatric surgeon on call, arrived after rushing from home. He needed to access the bullet path and "sew and cauterize the torn veins," Prudente writes. Stewart rushed the infant to a pediatric OR to get the job done.

One in a million

It was an arduous operation, and the boy took almost two full body volumes of blood, Prudente reports. "Meaning everything is going out, and you're putting it all back in," Stewart explained.

But the care team prevailed. One month later, Sims left her hospital bed and walked to the neonatal ICU. The bullet had not hit her son's subclavian artery, and although he needed a ventilator for two weeks, his brain was not harmed.

Stewart said the boy was extraordinarily lucky. "It was like a 1-in-a-million shot that you could go through and through the uterus, actually hit the child and not kill him," he explained.

Sims named her infant Chance (Prudente, Baltimore Sun, 11/11).

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