X-Message-Number: 29943
Date: Wed, 17 Oct 2007 02:11:03 -0400
From: "Charles Platt" <>
Subject: Alcor Conference Report: Part 3

Alcor Conference Report by Charles Platt: Part 3
_____________________________________________________________

The opinions stated below are entirely my own. Although I
continue to work as a consultant for Suspended Animation, I
am not an employee and do not speak on behalf of the company
in any way.
_____________________________________________________________

Sunday Afternoon
_____________________________________________________________

a) Lunch

Outside the Alcor building I found tents set up with a
barbecue in progress. Actually I should say that we were
offered the *results* of a barbecue, in the form of a huge
mound of shredded pork in a steel pan. At first I thought it
was a heap of tuna fish. The "vegetarian alternative" was
lasagna, but some hardcore carnivores chose the lasagna when
they saw the shredded pork.

This salty, fatty feast was a very odd choice for a "Life
Extension Foundation." I have to say that it reminded me of a
bad buffet at a rural meeting of the American Legion.


b) Tours

This year Alcor reorganized its tour procedure so that
limited groups of visitors were taken through the facility by
individual guides. You had to sign up for a tour group in
advance, and could choose your guide. While I think this is a
very good procedure, the groups were rather large (the limit
seemed to be about 20 people) and most people wanted to take
the early tours so that they would have time to travel home.
Since the tours seemed very popular and were such an
important feature of the conference, it might be a good idea
to allow more opportunities for smaller groups earlier in the
day. Tours could also constitute one track of multi-track
programming.


c) Rat Lab

Tanya Jones showed us the new rat lab which has been set up
primarily by Chana Williford. This looks ready to begin work,
and should have the potential to yield some interesting
results. Tanya said that one goal is to determine how long an
animal can be placed on bypass, in the hope of applying the
results to human cases where a patient has to wait for
official documents (sometimes for up to 48 hours) before
transport across a state line. Since a long waiting period
has the potential to inflict ischemic injury which I believe
may be irreversible, the goal seems worthwhile. However I
heard subsequently from other sources that the rat research
is more open-ended than I understood from Tanya, and its
goals are not yet formalized. I look forward to
clarifications from Alcor on these topics.


d) Surgical/Cooldown Pod

Steve Van Sickle took over and showed the "pod" which has
been built as a combination operating table and rapid cooling
enclosure, with associated vitrification circuit controlled
by LabView software. I was very impressed by the pod, which
has been beautifully made and seems well engineered.

The software to control the vitrification circuit attracted a
lot of attention from the group. Many people were excited by
the two computer monitors displaying nice graphics. This
caused me some chagrin, since I was similarly impressed three
years ago when I visited Suspended Animation and saw David
Hayes doing a demo of a LabView vitrification control system.
At that time I was too naive to realize that the system had
very little functionality beneath its user interface.

However, so far as I can tell, the new Alcor system seems
very functional indeed.

LabView is a graphical computer language designed to control
equipment such as motors and pumps in response to variables
such as temperature and pressure. Originally this language
was supposed to be so simple, scientists could write their
own code on a do-it-yourself basis. In reality, almost all
applications today seem to be written by professional LabView
consultants who may receive as much as $100/hour (in Florida,
at least; I don't know about Arizona). Since the software and
the associated hardware (sold by the same company) are
extremely expensive, LabView has strayed far from its
original promise of being "the people's lab language."

In the past, Alcor tried to minimize the expense by allowing
a non-programmer named Jeff Benjamin to create some LabView
code on a semiprofessional basis. After the predictable
consequences, Mathew Sullivan took a shot at fixing it. While
I was working at Alcor we hired a "real" LabView programmer
who had some great ideas but tragically killed himself when
the job was half finished. Finally Alcor has found someone
who, I am told, authored some of the official LabView
documentation. He seems to have done a good job.

To fulfill its design goals, the pod must maintain an
environment for the patient slightly below 0 Celsius during
the final stages of perfusion with vitrification solution.
When the terminal concentration is reached, a double-walled
clear acrylic cover is placed over the patient and vapor from
liquid nitrogen is circulated to reduce the body temperature
to the glass transition point as rapidly as possible. Speed
is important because a lower temperature minimizes
cryoprotectant toxicity.

We were told that Alcor's unit has gone only as low as -80 so
far. Temperature reduction becomes increasingly challenging
the lower you go, but Steve seemed breezily confident when he
said that there will be no problems getting down to -130.

I asked about vapor circulation inside the pod, since I have
heard a best-guess that a minimum speed of 15 mph (22 feet
per second) is needed to disrupt the boundary layer of "dead
air" around the body. Steve however told me that I am
"incorrect" and declined to discuss it further. Subsequently
I spoke to Hugh Hixon who said that based on his past
experience he believes relatively little turbulence is
necessary. On the other hand he agreed that he has not
measured the vapor speed and has not tested the pod fully.

Therefore the pod seems to be unproven at this point. I
wonder if people taking the tour realized this. For instance
at http://frontierchannel.com/category/events/ a description
derived from the Sunday tour assumes rather credulously that
the new perfusion system is ready for patients. Perhaps Alcor
tour guides should be cautious about allowing visitors'
enthusiasm to run away with them.


e) Portable Ice Bath

Steve led the group into an area which used to be the wet
lab. A huge cleanout operation has been completed, and the
area was being used for displaying standby equipment.

I paid special attention to Alcor's "basket style" portable
ice bath (PIB), for two reasons. First, I have designed
several ice baths myself over the years and am wearily
familiar with the difficulties involved. Second, Alcor's ice-
bath situation has been unsatisfactory during the last ten
years.

A PIB is fundamental in cryonics. If transport from the
bedside to the location where blood washout will occur is
going to take more than a minute or two, you absolutely have
to place the patient in an ice-cold environment. Alcor has an
ice bath built into its rescue cart in its vehicle, but the
rescue cart has limited mobility because of its great weight
(it can be lifted over a curb only with significant
difficulty, and cannot be lifted over multiple steps). Also
an urgent case may occur which is outside of the vehicle's
range. In such situations a collapsible PIB must be used, and
must be acceptable as passenger baggage by domestic airlines.

During the last ten years Alcor has not had a really
acceptable design for this purpose, at least so far as I am
aware. I believe the PIB inventory at Alcor consists of the
bath built into the rescue cart, a noncollapsible bath that I
specified during my tenure at Alcor for use with a Chevy
Suburban while the transport vehicle was being completed, and
a collapsible PIB based on a design that I executed about 15
years ago. After Mark Connaughton modified it to make it
stronger, it became difficult to use and deploy, and was
refused by an airline on the one occasion when I tried to
deploy it, because it exceeded the weight limit. I had to
take it back to the Alcor facility, repack it in two pieces,
and then return to the airport.

About ten years ago Fred and Linda Chamberlain introduced
something that came to be known by California standby team
members as the "Flimsy PIB," so named because it consisted of
a body bag supported at each corner by thin metal struts
which would collapse if you leaned on them. While it was
ultra-portable, ultra-simple, and ultra-cheap, it had no
integral strength and had to be placed on a gurney, which
team members might or might not be able to borrow for the
occasion. Really the Flimsy PIB was less than ideal, but many
copies were distributed to regional Alcor groups, and so far
as I know, they're still out there. I would think that
replacement of it is overdue.

When I started working at Suspended Animation I developed a
folding PIB design which is very compact, very strong, but
quite heavy, since it is made entirely from stainless steel.
Fabrication costs were high because the design was complex
and took a long time to build. Suspended Animation now has a
welder who has been able to duplicate the design in one week
(for deployment in Southern California) and believes he can
reduce the time still further.

Meanwhile Alcor has followed a different path, purchasing an
off-the-shelf mountain-rescue stretcher that resembles a
shallow basket, with thin chickenwire stretched over a
tubular aluminum frame. For airline transport it folds in the
middle like a clam shell. Since the basket isn't deep enough
to contain the necessary amounts of ice and water, Alcor
added a separate rail to support a vinyl liner. The rail must
be detached during shipment and reattached for use. Alcor
also added two pairs of wheels, each mounted on a small
subframe. These also have to be detached during shipment.

During the 2006 Alcor Conference the first version of the
basket-style PIB was displayed to visitors. While I did not
attend that conference I examined photographs which led me to
conclude that the PIB was not yet ready for prime time. The
wheel subframes were secured temporarily with spring clips,
the rail looked as if it could have detached itself from its
little wooden separators if anyone had tried to use it to
lift a loaded bath, there was no IV pole, the hinged design
would not "fail safe" since it would tend to fold in the
middle if its retaining clamps broke, there was no provision
to use the side-access Thumper (CPS device) which Alcor owns,
the bath looked too small for tall or obese patients, and I
wondered if it was strong enough for rough handling when it
was fully loaded with a body and a lot of ice.

Lastly there was no way to reduce the length of the bath to
fit in elevators or go around tight turns in hallways. One of
the many things I learned from Hugh Hixon over the years is
that articulated or telescopic ends to a PIB are very useful
for this purpose. I also learned from the PIB developed by
David Shumaker and Mike Quinn before I joined Suspended
Animation that a waist-high PIB has immense advantages. The
Alcor version, like its predecessors, is at floor height,
which makes manual CPS very awkward. Also, since a patient
must be elevated before blood washout can begin, either the
patient has to be lifted out of the PIB onto an operating
table, or the entire PIB has to be raised.

During the past year at Alcor some incremental progress has
been made with the basket design. When I peered under it I
found that the wheel subframes are now attached with cable
ties instead of spring clips, which is some improvement,
although presumably not the final configuration. The rail is
now attached with clamps, but when I asked if an Allen wrench
is needed to remove the rail for air transport Steve said
that Alcor is going to improve the design (he did not say
how). I still didn't notice an IV pole, and didn't see a
carrying case, which made me wonder if Alcor plans to air-
transport the basket design without additional protection. I
would guess that the chickenwire would be vulnerable to
damage during baggage handling. However I am speculating
since Steve was not very receptive to questions, either from
me or from others on the tour.

The new vinyl liner for the ice bath looked nice, and of
course the big selling point for the design is its cheapness
and light weight. Overall however I still tend to think that
the requirements for an ice bath in a cryonics case are so
unusual and so different from anything in conventional
emergency medicine, I question whether medical equipment can
be adapted successfully. The lack of articulated or
telescopic ends to the basket-PIB remains a significant
issue, and the inability to use a standard Thumper is a
problem. Possibly the single LUCAS CPS device that Alcor owns
could be placed in the PIB. Steve said that this would be
possible, but the LUCAS was not on display.

I have always been very impressed by the very simple PIB
design created by Alan Sinclair in England. He used color-
coded PVC tubes which plug together. This is not especially
elegant but is very simple, very strong, very cheap, and like
everything that Alan builds, very practical. Since there is
such a pressing need for an Alcor ice bath, the Sinclair
design would be a good stopgap measure. One PIB could be
built within a couple of days. Multiple copies could be
distributed to regional groups within a couple of weeks.

During the tour, it was not clear to me whether the basket-
style PIB is considered finished. My guess is that it is
close, but not quite ready for deployment.


f) Minimizing Standby Kits

Steve gave great emphasis to a current endeavor to "minimize"
standby equipment. Supposedly Alcor will reduce the number of
Pelican-brand transport containers from 7 to 3, although he
did not say what would be left out to achieve this. Since
Suspended Animation has gone in the opposite direction,
*adding* several containers during the past three years,
obviously I am out of sympathy with the Alcor approach. But
without more information there is not much to say, except to
note that the 3 Pelicans do not include a mechanical CPS
device, which I would have thought is fundamental.


g) ATP

Also on display was a new version of the Air Transportable
Perfusion kit (ATP) which is slightly smaller than the old
one, largely because it is built around a one-piece off-the-
shelf medical item containing oxygenator, heat exchanger,
pump, and arterial filter. A separate motor is required for
the pump, and a separate reservoir.

The principal advantage of this system is that it gets rid of
the massive occlusive pump that has been a fixture in Alcor
kits for many years (and is still used at Suspended
Animation). I would be delighted to retire that piece of
equipment, but I don't know whether the centrifugal pump in
the new Alcor system is capable of equivalent performance. In
particular, I wonder if it can deliver 3 liters per minute,
and whether it can develop a pressure of 250 mm mercury.
While such a high pressure would normally be required only
when using a high flow rate with the smallest cannula
(generating considerable back pressure), a consulting
perfusionist who advised Suspended Animation did advocate
this capability.

In addition the new Alcor ATP did not seem to have a good
pressure monitor; the reservoir bag was very small (could
easily be made bigger); and I didn't see high/low liquid
level alarms. The new ATP did not have the same level of
finish as the surgical/cooldown pod and looked as if it might
have been put together just for the tour day, although I may
be wrong. I suspect that it is not ready for deployment.

I left the tour at this point. The additional things I wanted
to know would have been of little interest to other people
taking the tour, and I felt it was impolite to take their
time.


h) Conclusion

I was puzzled by the decision to minimize the number of
containers in transport work, because this seems a secondary
issue to me. Surely the primary concern is whether a cryonics
organization is ready to do cases. This readiness issue is
very mundane and rests on wearisome tasks such as inventory
control, swapping out expired meds, running training
sessions, practice sessions, and emergency simulations,
finding medically qualified help, writing SOPs, and
performing inspections. Hardly anyone enjoys this kind of
work, and moreover, no one receives any special reward for
doing it well. Thus for many reasons it tends to acquire a
low priority and may even be overlooked in favor of more
interesting tasks.

"Readiness" is not something that most people see or notice
when they are touring a cryonics facility, and thus the
cryonics organization may feel more incentive to show a new
piece of equipment rather than try to convince everyone that
readiness has reached a pinnacle of excellence.

You really never know how good your state of readiness is
until there's an emergency, and even when that occurs,
outsiders may still not know if you did a decent job, unless
you take the time to produce a very detailed and honest case
summary.

The Alcor visit was interesting, and I especially admired the
work that has gone into the surgical/rapid cooling pod. But I
could not tell how much progress has been made toward the
goal that I regard as most fundamental.
_____________________________________________________________

Needless to say, this entire report reflects a viewpoint of
just one person who is by no means typical of Alcor's
membership. Indeed, while I remain passionate about cryonics,
I am not a member of Alcor at this time.

--Charles Platt
_____________________________________________________________

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