X-Message-Number: 2785
Date: Sat, 28 May 94 20:55:03
From: Steve Bridge <>
Subject: CRYONICS Recent Alcor Suspension
To CryoNet
>From Steve Bridge, Alcor Foundation
May 28, 1994
There has been a lot going on the past three weeks, and I haven't
had time to post anything. I will try to catch up in the next few days.
Some postings will duplicate columns in the next Alcor *Phoenix*.
If you wondered where the April *Cryonics* went, we got way behind
with the move and a suspension (see below), but it has been mailed.
Members' copies were mailed 1st class and most members should have
received them by now. The rest were mailed at book rate (not bulk), so
they will get out quicker than usual, too. We're working on the May
*Phoenix* now and hope to have it mailed next week. If we can then get
the June *Phoenix out only 2-3 weeks late, we may get close to caught up
by July or August.
Long time readers of *Cryonics* will remember that this string of
late issues is the usual result of busy times. And boy, are things
busy.
The below report is shortened from Tanya Jones's preliminary
report, with additions by me. A longer version will be in the May
*Phoenix*, with a much more detailed report in the July *Cryonics*.
Readers of this preliminary version should be cautioned that a lot of
detail has been left out, changes are likely before the final versions,
errors in times and procedures may be present, and that many aspects of
evaluation are still incomplete.
****************************************************************
Transport and Whole Body Suspension of Alcor member A-1206.
April 31-May 1, 1994.
Alcor's first New York City suspension (and only its second on the
East Coast for many years) was another lesson in geography and in
Murphy's Law. The East Coast is still VERY far away from the West Coast
(or from the Arizona desert), and suspensions still happen at the worst
time possible.
Four members of the staff Suspension Team (Tanya Jones, Hugh Hixon,
Michael Perry, and Ralph Whelan -- plus staff member Derek Ryan and
several other frequent suspension team volunteers) were in Sunnyvale,
California (in northern California) attending the Extropy conference on
April 31. At 8:30 a.m. (PST) Saturday morning, the call came in that an
elderly New York member had been found by her son (an Alcor member) in
an unresponsive state and was in the hospital after what turned out to
be a late-night heart attack. Steve Bridge was in Scottsdale, trying to
take his first day off in a month, and came in to Alcor right away.
Tanya Jones and Hugh Hixon were paged at the conference and began
preparations to fly to New York. About 10:30 a.m., "Mrs. N's" physician
told Steve that that Mrs. N was in a coma and, given her age of 91 and
her previous medical history, he did not expect her to survive through
the next night. By this time, Hugh and Tanya were being rushed to the
airport by Keith Henson (who was also attending the conference).
Their flight was scheduled to leave about noon, but actually left
45 minutes later. Communications between Hugh, Tanya, and Steve were
intermittent, although we did fairly well for the first 5 hours.
Fortunately, Tanya and Hugh had access to a phone at their seat; but the
staff in Scottsdale had to use Tanya's Skypager to tell her to call
them. Interestingly, the Skypager does work at 30,000 feet; but there
were many "dead spots" in that coverage as the plane moved east of the
Mississippi.
In short order, Steve Bridge had arranged to have Scott Herman take
the field transport kit, blood replacement solution (Viaspan), and
shipping box to the Phoenix airport, where it would await the next
flight. New York Transport Team members had been notified of the likely
suspension and told to go to the hospital.
About 1:30 p.m. PST (4:30 p.m. EST), while Steve was on the phone
with a New York City mortician (previously arranged by the New York
members) coordinating the use of his facility and services, the
mortician took another call that the patient had died and was awaiting
removal. Hugh and Tanya were still four hours away. Only one Transport
Team member, Stanley Gerber, had arrived at the hospital; and he did not
have the medical kit or other equipment. That was with Gerry Arthus and
Curtis Henderson way out on Long Island. Gerry and Curtis took longer
to load the equipment than was planned, and they added another long
delay by trying to rent a van as back-up to Curtis's unreliable vehicle.
Fortunately, the hospital was willing to help the member's son pack
the patient in bagged ice; but they were not willing to administer
heparin or other medications nor to supply them to Stanley. They WOULD
have allowed him to administer the meds if the med kit had been there.
(A number of possible future solutions to this problem are being looked
at.)
After discussing probable transport scenarios with Hugh, Tanya
asked Steve to stop the transport kit shipment to New York, as it
appeared unlikely that we'd use it. We expected that no blood
replacement would be possible due to the excessive clotting which was
likely to occur since the team was not at the hospital to administer the
anti-clotting medication, and since Hugh and Tanya would not be able to
arrive and initiate the washout procedure for several hours.
After further consideration, Tanya and Hugh changed their minds--
the transport kit should be sent, as there were many items in it that
were not in the local kit, and it did appear that a partial washout
still might be possible. Twenty minutes passed between these decisions,
and they were poorly timed. The only flight which would get the kit to
New York before late Sunday morning (this was Saturday) had been the
plane from which the kit had been off-loaded, and it had just left.
Unfortunately, the shipping box and washout solution were also not sent.
(One rule Steve learned here: when in doubt, send the transport kit. It
won't do any good sitting at Alcor and may well do good in the field.
Besides, sometimes the situation changes and your team will need the
most flexibility possible.)
To remedy part of the problem, Steve called Dayna Dye at the
Cryonics Society of South Florida (where Alcor and CSSF maintain a small
cryonics facility) and asked her to ship the Viaspan stored there to New
York. The mortician insisted he had a water-tight shipping container,
so we didn't worry about the lack of the specialized cryonics shipper.
The mortician arrived at the hospital about an hour and fifteen
minutes after the patient's legal death and submitted the paperwork for
the removal of the patient. The mortician and patient, with Stanley and
the patient's son, arrived back at the mortuary about 6:30 p.m. Gerry
and Curtis arrived at the mortuary at about 8:15pm (EST), with Curtis'
van making the trip without incident. They found the patient, with
her head still packed in ice, and the patient's son, nearly frantic at
the delays which were occurring. Stan had just left for the airport
with Mrs. N's son to pick up Hugh and Tanya.
Once the equipment was unloaded from the van, Curtis and Gerry
began to implement the transport protocol. The mechanical CPR device
was placed and started. An IV was in place, but no fluid could be
pushed through the clotted line. Of all the transport medications, only
Maalox (to prevent stomach ulceration and bleeding) was administered at
this time.
Once Hugh and Tanya arrived at the mortuary, they began considering
their options. They also had no luck in using the clotted IV line to
inject medications, and the Viaspan wouldn't arrive for another two
hours. And the mortician had come up with an even more serious problem.
No airline would accept the patient for a flight out of New York that
night or the next morning because all of the cargo areas at Sky Harbor
Airport in Phoenix were closed on Sundays!
This unforeseen complication resulted in the patient's son
searching the phone directories for an air ambulance company which would
transport his mother (plus Tanya and Hugh) to Phoenix. These proved to
be quite expensive, and no airline had an available plane large enough
to transport the patient without refueling stops (which could ultimately
prove more time-consuming a trip than a commercial airline). Also, any
available planes could accommodate one or *no* passenger. Steve began
searching for an answer to this in Scottsdale, by contacting all of the
airlines with New York to Phoenix flights, in hopes that an exception to
the shipping schedule could be made; but given that this was late
Saturday evening, the prospects for a timely resolution seemed slim.
Tanya and Hugh consulted with a cryobiologist about the probable
extent of the ischemic damage (nearing six hours at this point) with and
without the blood washout, and the effects that further delays (in
shipping) would have on the patient's chances for a successful
cryoprotective perfusion. They concluded that attempting the blood
replacement would do no harm, as it would not delay the shipment (still
scheduled for Monday) and might provide her brain with some protection
if clotting didn't prevent washout. With this decision made, Hugh
expended a lot of energy cleaning out the mortician's adjustable
embalming pump, which he intended to use to flush the Viaspan.
Meanwhile, back in Scottsdale, Steve had found an America West
Airlines employee who cared. The employee thought getting cryonics
patients back to Arizona was important enough to spend two hours
tracking down supervisors at home and at parties to get permission to
break the rules. He also found a couple of cargo area employees willing
to come in on their day off to receive the patient, and persuaded the
New York cargo department to waive the usual "four hours before the
flight" arrival deadline for cargo. Hugh, Tanya, and the patient had
space reserved on a 7:30 a.m. flight out of JFK.
The mortician was experienced with femoral cutdowns, of course, and
helped Hugh and Tanya by doing one very quickly. At about 1:00 a.m.
they were able to start the flush. Immediately, they noticed dark
venous blood exiting the circuit. This was a good sign. As the flush
continued, they noticed her abdomen distending. It was filling with
fluid, probably leaking from the circulatory system through a ruptured
gastric lining. By the time Hugh shut down the pump, about six liters
had been flushed (generally, we use about twelve) and the venous return
color had markedly lightened.
With the washout completed, the transport team discovered some of
the New York equipment missing. We had no sealable bags in which to
pack the ice for shipping the patient and no water-tight "body bag.".
Stan and Curtis combed the neighborhood (not the best part of town) at
2:00 a.m., looking for an open convenience store. Their search was
unsuccessful, but the mortician assured us that his shipping container
was water-tight.
With the flight deadline getting close, the team packed the patient
with the ice in the original bags into the container, surrounded it
with insulating material (which had been originally slated for the
mortuary basement's renovation), and secured all of this within an outer
casing. Then they dashed to the airport.
The mortician was wrong. While Hugh and Tanya waited for the
plane, Steve got a call from the mortician that the shipping container
was leaking and the patient would not be allowed on the flight. The
mortician took the patient back to his facility, while Hugh and Tanya
headed back to Arizona to assist with operating room preparation.
The mortician still couldn't find anyone with sealable bags; but
did find some garbage bags with twist ties. After drying out the
container and laying in new insulation, he filled the garbage bags with
ice, and placed them with the patient into two non-watertight "disaster
pouches." This time it worked, and the patient was placed on the next
available America West flight to Phoenix, about five hours after the
originally scheduled flight.
(When Tanya and Steve met with Gerry and Curtis two weeks later,
Gerry told them that the missing box had been found at the mortuary
while they were cleaning up after the transport. A "helpful" mortuary
employee had stuck it in an out-of the way corner.)
Hugh and Tanya arrived at Alcor to find the facility nearly
prepared with several staff and volunteers at work. Ralph Whelan, Keith
Henson, and Jay Skeer had arrived from Northern California (and Mike
Perry came in shortly thereafter). Paul Garfield, a Texas cryonicist
"just passing through," had been recruited, and several new local
volunteers were being pressed into action.
Steve and Scott went to the airport later in the afternoon to pick
up the patient and Alcor's physician, Dr. Thomas Munson, who was
arriving on another flight at the same time. By the time they had
returned from the airport, Alcor's surgeon Dr. Nancy McEachern had
arrived with Dave and Trudy Pizer.
The surgery and cryoprotective perfusion promised to be difficult,
given the known ischemic damage and the patient's medical history, which
included a previous heart-bypass operation. This case also promised to
be educational, for similar reasons. In spite of the difficulties
presented, it appears that the surgery and cryoprotective perfusion went
very well, and the patient received a much better suspension overall
than might have been predicted.
As expected, the by-pass operation had left few recognizable
structures in the patient's chest. Scar tissue was a real hindrance.
Sutures from the patient's previous bypass were the only indicators, in
one case, which made an anatomical feature identifiable. (Similar
complications have been seen in previous suspensions where patients have
undergone bypass operations.) When the surgery got particularly
difficult, Keith Henson (assisting Dr. McEachern) and his engineer-mind
proposed an innovative way to complete the perfusion circuit. His
method eliminated much of the delicate dissection required to free the
fragile walls of the descending aorta enough to place a clamp to remove
the lower extremities from the perfusion circuit (a neuro-perfusion
circuit was used in this whole-body case, for reasons which will be
discussed in the *Cryonics* article). The connections were completed
shortly thereafter. Bypass was started at 8:30 p.m. (PST) Immediately,
several large blood clots were displaced from the heart, but subsequent
perfusion looked good, and the patient's pressures were comfortably
high.
Based on the suggestion of one of our consultants during this case,
two burr holes were prepared, so that we could observe both hemispheres
of the brain for signs of edema (swelling). This showed us that the
hemispheres may swell to different extents (right approximately 1.0mm,
left about 3.0mm) and is a technique which will be used on future
ischemic patients.
At the start of the perfusion, the brain swelled to the extent
mentioned above. As soon as the swelling was observed, the rate at
which cryoprotectant was introduced to the patient was increased, in the
hopes that higher osmotic pressures could reduce or eliminate the
advancing edema. The swelling did not appear to get worse after this
point, but we continued to watch the burr holes very closely to
immediately catch any further edema (which would have resulted in the
perfusion being halted). A sudden and dramatic loss of perfusion
pressure ultimately caused the perfusion to be stopped, with burr hole
leakage containing a final molar glycerol concentration of 4.7M (other
measured concentrations were 8.8M arterial and 7.6M venous).
While the surgery was in progress, Scott Herman and Monty Walters
(another local volunteer) were working furiously to modify the automated
neuro-patient cooldown system to perform a whole-body cooling. They
completed a week's worth of work in hours, finishing the project shortly
after the conclusion of the perfusion. While they were finishing the
last modifications, the patient was being prepared for the cooldown
phase of the suspension. The patient was transferred into the silicone
oil bath shortly after having been placed in protective bags.
The cooldown system worked nearly flawlessly from the start,
despite its hasty implementation. Because the programming hadn't been
tested prior to being required for a patient cooldown, Scott, Mike
Perry, and Paul Garfield got little sleep over the next day or two, as
they alternated shifts to monitor the cooldown system in case of any
program failure.
Transfer of the patient to the second-stage cooling dewar occurred
on Thursday following, and the nitrogen cooldown was completed about 1
week later.
One other unusual aspect of the suspension was that since the
patient was Jewish, her son requested that a rabbi be asked to give a
blessing at her dewar. Steve had earlier given a cryonics talk to
senior citizens at a Phoenix-area Jewish Community Center and was able
to use that contact to locate a liberal rabbi who was very interested in
visiting Alcor. The rabbi performed the ceremony and spent quite a bit
of time with us, speaking of how cryonics might fit into Jewish beliefs.
It is important for CryoNet readers to remember that, while the majority
of cryonicists are not religious, many are. Cryonics is a technology
and is neither a religion nor an anti-religious movement. As more
religious people become exposed to cryonics in the future, and as some
of their leaders begin to find ways to fit this new idea into their
beliefs, the number of religious members is very likely to grow, perhaps
significantly.
We thank the many people who volunteered on this suspension. A
complete list will be published in the *Phoenix* article.
We'll write more about this later; but it should be apparent to
everyone that local response is critical to the early steps of a
suspension. If you wait for "someone else" to make local arrangements,
they may never get done. Three New York cryonicists did have basic
transport training, a lot of equipment, a van, and a cooperating
mortician. But beyond a very few members, there had been little serious
commitment to help with this effort.
Tanya and Steve met with the New York members last weekend, and we
think they now understand the importance of direct action and
involvement on a personal level. They appear to have the commitment to
improve the situation for future suspensions. I hope other New York
cryonicists will take heed and help them. And I hope cryonicists in
other regions of the country will take more responsibility for
themselves and their friends as well.
Alcor Life Extension Foundation
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