If Kennedy was alive today, he’d still be dead

Half a century after the assassination of US senator Robert F. Kennedy, a new report finds that the gunshot wounds he received in the early morning hours of June 5, 1968, would most likely still have been fatal or severely debilitating now, despite advances in medical technology and procedures, and that he “received aggressive and appropriate care in line with the standard of the day”.

At the time of his death, Kennedy, a former US attorney-general and younger brother of assassinated president John F. Kennedy, was himself an aspiring candidate for the US presidency. On June 5, following a speech at the Ambassador Hotel in Los Angeles, after winning the California presidential primary, he was shot several times. He died of severe brain injury on June 6.

The highly detailed report, published in the Journal of Neurosurgery, is by a team of medical researchers from Duke University, in North Carolina.

It reviews eyewitness reports of the shooting, the immediate care rendered, the clinical course, and, finally, the autopsy. It also discusses differences and similarities between 1968 and 2018 with regard to the care of patients with gunshot wounds to the head.

The discussion of autopsy findings is supplemented by an artist’s depiction of the extent of Kennedy’s head injury. The report describes in detail the autopsy, which began on June 6, and says it has been called “the perfect autopsy” for its attention to detail.

“At its conclusion, the autopsy documented three gunshot injuries,” the researchers write.

“One bullet entered the right axilla posteriorly and exited near the right clavicle. The second bullet entered the back on the right side, lodging at the base of the neck in the subcutaneous space. Neither of these injuries caused life-threatening harm.

“The lethal injury to the right posterior auricular region had associated powder burns on the skin, and therefore the chief medical examiner stated that the gun was within three inches when the shooting occurred.”

The report makes note – but does not otherwise comment – that the shooting of Robert F. Kennedy is the subject of numerous conspiracy theories, mostly involving his killer, Sirhan Sirhan. In May, Kennedy’s son and daughter, Robert F. Kennedy jnr and Kathleen Kennedy Townsend, told the Washington Post that they supported calls for a reinvestigation of the assassination.

The report comments on several differences in medical practice as it is today, which reflect advances in neuroimaging and neurocritical care, rather than the technical aspects of surgical treatment.

For example, diagnostic tests that are commonplace today, such as computed tomography (CT) and CT angiography and venography, were not available. The surgical procedure performed in 1968, a craniotomy, however, was similar to what would be performed today. Some post-operative monitoring techniques and preferred medications have changed over the years, too.

As with many other aspects of trauma care, the report says, the management of cranial gunshot wounds has evolved from lessons learnt from combat situations. It refers to the work of Harvey Cushing, sometimes referred to as the pioneer and father of neurosurgery, who in 1918 published his observations on penetrating head trauma from World War I.

Cushing proposed a grading scale based on the extent of projectile penetration and whether the ventricular system was injured. The group of patients in his collection whose injuries most closely mirrored those of Kennedy had a 54.3% mortality rate, which “unfortunately holds true in modern series of cranial gunshot wounds”.

As for whether Kennedy could have survived if he were to be treated using 2018 medical techniques, one of the study’s authors, Duke University researcher Jordan Komisarow, says: “By all accounts an aggressive and valiant effort was made to save the senator’s life. Unfortunately, a similar injury would likely also be fatal, or severely debilitating, in 2018.”

Co-author Shivanand Lad adds: “Despite numerous advances in imaging, anaesthesia, and surgical technique over the last 50 years, damage to the brainstem and its associated blood vessels continues to be a devastating and catastrophic injury.”