X-Message-Number: 2855
Date: 06 Jul 94 17:38:59 EDT
From: Mike Darwin <>
Subject: CRYONICS Small Groups

More on Robert Cardwell's post and the situation of the Australian group.

After thinking about the Australian Group's situation in light of what Robert
has said about their capabilities I would like to add the following thoughts.

If you have a blood pump or other acceptable pump and a simple circuit with a 40
micron alterial filter AND you have the capability to mix and filter perfusate
(again a pump capable of generating enough head to push the perfusate through
the 0.2 micron filter is needed)  AND you feel confident about setting up a
flush circuit and doing cannulation  (with or without assistance from a
mortician) I think you would be FAR better off to go ahead and carry out
cryoprotective perfusion and freezing locally.  How would you do that?

1) Start out with a single pass batch of 10% glycerol in MHP (consult Mike
Perry's paper for the volumes you'll need -- or better still consult Mike
Perry).  You will probably need about 20 liters for a neuro -- this presumes
using both carotids and both jugulars (i.e., perfusing just the head) -- this
may be contraindicated in some patients due to atherosclerosis, etc.

2) Make your next batch 25% -- again about 20 liters for a neuro.  Keep your
pressures to between 40 and 60 mmHg.  You can place venous cannulae to act as

stents and put a connector with port on each one so you can draw venous effluent
samples for later analysis.

3) Your final pass can be with 30 liters of 6.5 M (about 50% glycerol).

Surgically isolate the head using an electric carving knife and hacksaw (I use a
Black and Decker knife and a Satterlee amputation saw) and place the patient in
two plastic bags and submerge in n-propyl alcohol for dry ice cooling.  A whole
body simply requires you to have a metal tank (standard metal air shipper will
work -- this is what we used at Alcor for the first couple whole bodies) and 55

gallons of n-propanol.  N-propanol is about $150 per 55 gallons in the US  -- it
will probably cost more in Australia because petrol prices are about 2-4 fold
higher.  The point here is simple:  for a modest expenditure of funds and
acquisition of a modest additional amount of equipment you can easily do CPA
perfusion on-site.  Given the time-delays and logistic difficulties you will
likely encounter this is probably a worthwhile tradeoff IF you have mastered
open-circuit bypass.  Oh yes, and of course you'll need some whole body plastic
bags to protect from the alcohol -- Alcor has LOTS of these and they are not

As to delays, keep in mind that long delays have resulted in both cases of
shipping from outside the US in which I had involvement  (I am excepting Canada
here) because of bureacratic red tape.  In one instance the US consulate was
shut down for the weekend (normal practice) and it was impossible to even get
the permitting process *started * until Monday.  These people are NOT in a rush
to get permitting going fast and all of Carlos' efforts (which were herculean)
to get them in over the weekend were, as I recall, to no avail.  Additionally,
holidays (Australian *and* American -- I now believe that it is a holiday at
some where on earth EVERY DAY of the year) and vagaries of cargo can cause
massive delays.  I am currently doing some consulting for a person in Australia
who wishes to have his/her large dog frozen in Australia.  I made a call or two
about cargo and found out that there was NO cargo space (even for emergencies)
available for three days  -- on any airline that serviced Sydney to LAX  and I
made it a point to ask about shipping both medical perishables and cadavers!

Look at what sometimes happens inside the US: Alcor was almost unable to take
delivery on their last patient for another day or two because the Scottsdale
Airport airfreight terminals were closed for the weekend!  Also by way of
example, I recently found it IMPOSSIBLE to move personnel (even with an MD's
statement that it was a medical emergency) between the Bay Area and LAX -- and
we had a horrible time even getting a charter flight (air ambulance to move the
patient/personnel) because of icing and bad weather at Ontario Airport here in
Southern California  in MAY!!!!!

Thus, if you really have the people/capability I would urge you to go with
cryoprotective perfusion/freezing in Australia.

Also, as I understand it (perhaps I am mistaken) you are using a Pall 40 micron
filter in-line with a gravity flush system. This is extremely dangerous and
absolutely contrary to the manufactuer's recommendations -- and safe practice.
Normally, extracorporeal filters are primed with carbon dioxide gas before wet
priming and are then extensively circulated with liquid prime under high-flow
conditions (with a pump) to deaerate them (the CO2 is used to displace air
because it dissolves better in the prime than nitrogen and/or oxygen in the
air).  Unless this is done the filter becomes a SOURCE for air rather than a
trap for it (its only function when perfusing open circuit since the perfusate
will have been pre-filtered through a 0.2 micron filter and will not accumulate

particulates such as clumps of RBCs, clots, platelet aggregates, etc. during the
course of perfusion  -- these are a problem only if you close the circuit).
Thus, unless you can recirculate your prime and THOROUGHLY debubble your filter
by tapping on it (use a rubber exam hammer), repeatedly inverting it, and
recirculating fluid through it you are BETTER OFF WITHOUT ONE.  Indeed, a few
cardiothoracic surgery groups DO NOT RUN FILTERS at all! (I emphasize here that
this is minority practice in the US -- it is routine in third world countries
where the cost of the filter is prohibitive).

Anyway, I hope this is some of help to you and the other Australians.  Good

Mike Darwin

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