X-Message-Number: 16170
From: 
Date: Wed, 2 May 2001 03:26:53 EDT
Subject: Kryos News # 3

Kryos News # 3

A PARK OF YOU OWN

One of the biggest fears of people signed up for cryonics is that they may 
suffer an unexpected health emergency or catastrophic accident, allowing no 
time to notify their cryonics organization in advance. Even in situations 
where a patient is known to be terminal, legal death often occurs much sooner 
than expected. In fact, cancer patients and elderly, chronically ill patients 
have a far higher risk of sudden death than a patient recovering from a 
serious heart attack.

There are several reasons for this. Among the more obvious are that such 
patients often have compromised immune function as a result of treatment 
and/or the disease process. Chemotherapy can cause sudden overwhelming 
infection that can result in death in hours (sepsis). Several cryopatients 
have died unexpectedly in this way. Similarly, depressed immune function and 
increased susceptibility to infection in the elderly and others with bladder 
catheters or other invasive appliances can result in sudden death from 
infection. Patients with chronic obstructive pulmonary diseases (COPD) such 
as emphysema and asthma are also at risk of rapid decline and cardiac arrest. 
Closer monitoring of these patients' immune function, often with something as 
simple and inexpensive as a complete blood count (CBC) test, could greatly 
reduce the frequency of this kind of rapid and unexpected death.

Another cause of sudden death in cancer patients, particularly in advanced 
stages, is hypercoagulability. This is a big word for a simple problem: such 
patients tend to develop lethal blood clots in the vessels supplying their 
hearts (heart attack) or develop clots in the veins of their legs or 
elsewhere, which break off and partially or completely close off blood supply 
to the lungs. Cancer-associated hypercoagulability appears to be a result of 
activation of the immune-inflammatory cascade as a direct effect of the 
cancer cells, as well as due to ischemia in tissues being compressed
by the expanding tumor mass. Terminally ill cryopatients should be monitored 
for this
kind of change in blood clotting by doing prothrombin (PT) and partial 
thromboplastin time (PTT) tests. These tests are inexpensive, and, if they do 
indicate hypercoagulability, either Coumadin or a newer and safer drug, 
Plavix, can be given on a chronic basis to normalize clotting times. While 
this treatment isn't for every ill person, it could definitely help to reduce 
the incidence of sudden or very rapid death in patients at risk.

Still, these interventions cannot save everyone from the cryonics nightmare 
of sudden death. In cases where a healthy person suffers an accident, the 
patient frequently is autopsied by a coroner or medical examiner, but there 
are exceptions. Even if death occurs naturally, paramedics or morticians 
seldom have immediate access to heparin, which is a vital drug to prevent the 
blood clotting that will impede perfusion. Conventional medical personnel are 
even less likely to possess, or be willing to administer, other medications 
which a cryopatient needs.

In the past, Alcor addressed these problems by creating Regional Standby Kits 
which were placed with volunteers at key areas across the United States (and 
later in Europe and Australia). At Kryos we believe this is still a viable 
approach, although still not adequate in many situations.

How can each Kryos client have guaranteed, _immediate_ access to the critical 
molecules that could make the difference between a good cryopreservation and 
a very bad one? This question has become of even greater urgency with the 
advent of vitrification technology. Successful application of vitrification 
requires even the smallest brain vessels to be open and unobstructed. This is 
best achieved by rapid postarrest anticoagulation and the administration of 
compounds to inhibit biochemically mediated ischemic damage and inhibit cell 
swelling.

Unfortunately, such compounds are not on any hospitals' shelves anywhere in 
the world. And, getting them to a patient in a timely fashion is all too 
often impossible.

We at Kryos have what we believe is a major advance that will go a long way 
toward solving this problem. We call it the Past Arrest Response Kit or PARK 
for short. PARKs would be issued as part of a client's completion of 
arrangements with Kryos. The kit would consist of a cocktail of compounds for 
administration AFTER PRONOUNCEMENT OF LEGAL DEATH to inhibit ischemic injury, 
including blood clotting.

The PARK would also contain a disposable Active Compression-Decompression CPR 
device to facilitate much improved circulation/delivery of the 
ischemia-protective chemicals. We have developed an inexpensive prototype 
device which uses an adhesive pad to stick it to the chest. The instructions 
are simple: peel off the "wax paper" cover from the adhesive pad, place the 
sticky pad of the device midline on the patient's chest between the nipples, 
and begin cardiopulmonary support (CPS) by pushing down on the device with 
enough force to depress the chest wall by 2" and
pulling up after each compression with enough force to almost lift the 
patient from the floor, at a rate of 60 times a minute. An added advantage is 
that the use of this device eliminates the need for ventilation, since each 
upstroke of the device pulls air into the patient's lungs, much as the 
negative pressure in an iron lung was used to ventilate people in the past. 
Blood circulation of compounds administered IV is superior to conventional 
CPR using this approach.

Ventilation with room air during such CPS is actually less injurious than 
ventilation with high concentration of oxygen as is typically done during 
resuscitation efforts using CPR. What's more, the longer the patient has been 
ischemic (in cardiac arrest), the more beneficial room-air ventilation is, 
and the more harmful high concentration or pure oxygen ventilation would be.

As for protective compounds, the PARK "cocktail" will be packaged in a kit 
that will allow for either professional administration by a paramedic, nurse, 
physician, or mortician (a mini-cutdown kit will be provided for morticians) 
who can gain IV access, or where IV access is not possible administration via 
injection into the liver. The latter may sound difficult but really isn't. 
Fortunately, the liver is in about the same place in everyone and is very 
easily located by obvious external anatomical markers. Obesity will be the 
main problem, since overlying fat will increase the depth to which the 
administration stylette must be inserted.

The prototype is a sheathed device that protects the operator from the 
exposed sharp end of the stylette at all times and would remain in the 
patient after delivery of the chemicals. The latter has several advantages: 
1) It prevents a biohazardous "sharp" from being generated, 2) it allows us 
to determine if the positioning was correct, and 3) it will likely also 
contain a temperature probe which will allow for monitoring of the patient's 
core cooling using an inexpensive logging thermometer. The stylette assembly 
would attach to the patients' skin using cyanoacrylate (a chemical similar to 
SuperGlue). Cyanoacrylate is a water-catalyzed adhesive and sticks even to 
moist skin very rapidly and very securely.

If the operator misses the liver, no harm will be done, but no benefit will 
be received. However, since the patient has no other recourse, this strategy 
is still better than nothing, and in most cases the liver will be accessed. 
We have not quantified to what extent drugs delivered by this route will be 
distributed in patients, depending on the post-arrest time. Our guess is that 
distribution will be adequate in newly arrested
patients, considering that injection of dye into the liver or kidney of 
animals during CPR gives excellent and rapid distribution. Once Kryos has 
operational laboratory facilities, we will quantify and validate this 
approach in a relevant animal model.

For those who want them, and are willing to pay the extra cost, more advanced 
versions of the PARKs will be available for exclusive use by medical 
professionals or paramedics. Either way, PARKs will go a long way towards 
eliminating the sense of utter helplessness and vulnerability which most 
cryonicists feel. In many instances there will be paramedical, medical, or 
mortuary personnel available who can be persuaded to administer the compounds 
intravenously, obviating the need for trained Kryos personnel to be on site. 
Just having a lot of PARKs out there will allow us to use existing clients as 
an emergency distribution source of PARKs for at-need cases.

For instance, if we get a call that someone is going down near another client 
in Denver or Orlando, the client can ferry over a PARK to the hospital or 
mortician faster than we can get one there by courier or Federal Express.

The other part of the PARK will be a beefed up "body bag" and a special 
holder to facilitate packing the head in ice. Conventional body bags leak 
like a sieve. We will be using rugged water-tight material to eliminate this 
problem. The head icer will allow for much improved cooling of the brain. For 
those willing to pay extra we can also supply enough "instant ice" (KwikKold) 
to fill up the head icer. KwikKold is a product that produces a sustained 
endothermic reaction which soaks up a lot of heat. It
isn't cheap (though the ingredients are!) but it would be very effective as a 
first response until ice could be obtained. Just packing someone's head in 
KwikKold will reduce temperature in the brain fairly rapidly if the hair is 
wetted--and we will be providing a bottle of surfactant containing wetting 
solution for the hair. We are also looking into producing a KwikKold 
equivalent that would cost far less.

Finally, the PARKs will pack a lot of pharmacologic punch. Advisors 
associated with Kryos have learned how to get a lot of protective compounds 
into a small volume with a long, stable shelf life. If the PARK is 
refrigerated, its shelf life will be even longer. Refrigeration will have the 
additional advantage of reminding people about Kryos and their 
cryopreservation arrangements every time they open their refrigerator at 
home. Granted, it will take up some home fridge space and lead to some family 
"discussions." But we think it will be a net benefit.

A final concern is security and liability. The part of the PARK containing 
the cocktail of ischemia protecting compounds will be designed so that it can 
be opened without destruction of the contents only after an authorized Kryos 
representative has given the access code and determined it is legal and 
biomedically appropriate to proceed with use of the PARK.

This is one of many innovative solutions which Kryos plans on delivering to 
its clients. We're enthusiastic about the potential of the PARK to help 
dramatically improve the quality of care for a significant number of 
cryopatients.

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