X-Message-Number: 32734
Date: Tue, 27 Jul 2010 16:41:46 +0000 (UTC)
From: Melody Maxim <>
Subject: More Misleading Information from Harris

From Darryl Metz' Cryonet post, # 32726:
>>I read some posts from earlier this month in which it was said that teams
exist in hospitals that can attach patients in cardiac arrest to portable
perfusion machines. It was suggested that these teams could be used in
cryonics. That left me wondering why such teams aren't used routinely in
hospitals. Why on TV shows do we see doctors doing futile CPR and then
calling "time of death" rather than attaching patients to perfusion machines
while their hearts are stopped to buy more time?    Darryl<<


I saw the above question, just before I went out of town, for five days. I 
intended to post a simple response to the question when I returned, but now I 
see, in doing so, I'll have to address Steve Harris' response, (Cryonet message 
#32730), which I find to be mostly irrelevant to the practice of cryonics.


Harris, quite obviously, made the mistake of confusing something I described, 
with ECMO/ECLS procedures, so most of the research he invested in responding to 
me, (through Darryl's question), was a total waste of time, and probably only 
resulted in a great deal of confusion, for the readers of Cryonet. Though I 
suppose the term "ECLS" could, technically, be applied to the procedure I 
described, professionals actually familiar with what I was describing are 
unlikely to apply that label. We didn't do the long-term ECMO/ECLS procedures 
Harris discussed at length, at the two hospitals where I worked, but like ALL 
hospitals performing open-heart surgery, we were capable of providing the 
procedure I described (cardiopulmonary support (CPS), using a perfusion pump on 
a cart), in the hopes of getting a patient to the operating room and 
expeditiously resolving the underlying problem. The term "ECLS" (extracorporeal 
life support), is most often used interchangeably with the term "ECMO" 
(extracorporeal membrane oxygenation), to refer to very specialized, prolonged 
perfusion procedures, usually applied for specific cases of respiratory 
distress. Again, this is not the procedure I described, and has little to do 
with cryonics. In my previous post, I was simply pointing out that Harris was 
mistaken, when he offered up that femoral cannulations are performed under ideal
conditions, in conventional medicine, when the truth is they are frequently 
performed on an emergency basis and on patients with little-to-no blood 
pressure. (My previous exchange with Harris can be seen, here: 
http://cryonet.org/cgi-bin/dsp.cgi?msg=32689)


Harris writes: >>"The short answer (to Darryl's question), is because hardly any
hospitals have such teams."<<

That would be true, IF we were discussing ECMO/ECLS, but we weren't. We were 
discussing a form of CPS, meant to be applied for a short period of time, so 
Harris' "short answer" is misguided, at the very least. ANY hospital offering 
open-heart surgery has a team capable of delivering the level of CPS I 
described, and the last time I checked there were over a half-million open-heart
surgeries being performed each year in the US, alone. I live within 20 miles of
at least three hospitals, where open-heart surgery is performed, and most 
people reading this post probably live within a short driving distance of such a
hospital.


The REAL answer to Darryl's question is complex, and involves many factors 
related to conventional medicine, but unrelated to cryonics. In conventional 
medicine, many criteria must be met, in selecting patients for the kind of 
support I described. For example, the procedure can't be applied to anyone who 
is bleeding, because it requires a full dose of heparin. Heparin prevents blood 
from clotting, so administering the dose of heparin required for the procedure 
to a bleeding patient would only help them bleed to death faster. This means 
many trauma patients are automatically ineligible. The main requirements for the
kind of support I described is that all other (more conventional, less costly),
efforts must have been exhausted, and the care providers must believe the 
patient's problem is something they can resolve rather quickly, (such as with a 
surgical procedure). If a patient is put on this type of support, and then the 
care providers realize they cannot resolve the underlying problem, and cannot 
wean the patient from the machine, the hospital ends up with a very hopeless, 
and costly, situation. I've been involved in situations like this and, on more 
than one occasion, we ended up depleting the entire community's blood product 
supply and running up massive bills for the families of people who died anyway, 
in spite of our best efforts to save them. The two community hospitals had to 
cancel most of their scheduled (non-emergency) surgeries, in efforts to conserve
whatever blood products they had left, for unexpected emergencies, and they 
probably had to absorb much of the cost of the procedures. (Again, none of this 
has anything to do with cryonics, it is in response to Darryl's question related
to conventional medicine.)
 

Harris: >>"Despite the suggestion on this list that SOME do (have teams capable 
of placing patients on portable perfusion systems), based apparently on the fact
that very occasionally, cardiologists who have some arrest in the cath lab can 
get a perfusionist and open-heart surgical team assembled in time to save 
somebody."<<


It wasn't a suggestion, it was a fact. Again, all hospitals offering open-heart 
surgery have teams capable of performing the CPS procedure I described. The 
procedure does not require use of the cath lab, and is not limited to persons 
who arrest in the cath lab.  I've participated in these procedures, in patients'
hospital rooms, with only a surgeon and a perfusionist, and with a floor nurse,
or two, assisting. This procedure only requires equipment that is readily 
available at every hospital offering open-heart surgery.


Harris (to Darryl): >>"So, you're right-- it's very experimental and not 
standard of care."<<


Neither the CPS procedure I described, or ECMO/ECLS, are "experimental." These 
procedures have been around, (and used somewhat successfully), for decades. 
(Yes, they have a very high mortality rate, because the recipients of these 
procedures are usually in very critical condition, to begin with.)


Harris: >>"The hospital thinking about it must have shifts of perfusionists, 
cardiologists, and surgeons sitting around inside the hospital (or very near), 
waiting to run a portable bypass machine to the arrested patient bedside, for 
emergency "extracorporeal life support  (ECLS)."<<


Though I worked at two hospitals capable of providing the CPS procedure I 
described, neither one of them had "shifts of perfusionists, cardiologists, and 
surgeons sitting around inside the hospital...waiting to run a portable bypass 
machine..." Yes, we did have to live within "call distance" of the hospital (for
ALL our duties, mostly related to heart surgery, not that specific procedure), 
and the hospital staff was there to support patients with other methods, if 
possible, until we got there. The fact that these procedures are not frequently 
carried out is mostly due to the selection criteria, and has nothing to do with 
Harris' imagined lack of ability to carry out the procedures at hospitals where 
open-heart surgery is offered. Again, this procedure can be carried out at ANY 
hospital that provides open-heart procedures, something that really isn't that 
rare, these days.


Most of Harris' post was simple distraction, and didn't apply to the discussions
at hand, (those regarding cryonics procedures). None of the information he 
posted negates the fact that there are thousands of people capable of skillfully
performing femoral cannulations and perfusion, or that Alcor and SA can afford 
such personnel. Other than vascular cannulations and the use of perfusion 
equipment, the procedures Harris described have nothing to do with cryonics. In 
addition, Harris contradicts his previous (illogical) stance that perfusion 
procedures performed in cryonics are more complicated than those performed in 
conventional medicine. (I write "illogical," because Harris tends to be inclined
to argue that cryonics procedures are more difficult than virtually-identical 
conventional medical procedures, all the while supporting cryonics procedures 
being performed by laymen.)

Harris: >>"Cryonics can't just be done in STEMI centers."<<


No one has said it should be. All I've suggested is that the millions of dollars
being spent in cryonics, each year, should be used to provide persons competent
in performing femoral cannulations and perfusion.


Harris: >>"Tell us where it's being done. Tell us how many patients they've 
done. Give your references. I can't prove a negative, but people claiming the 
present workability of general ECLS for a whole prospective population, have the
responsibility of giving your numbers."<<


Harris asking for numbers related to very specific perfusion (ECMO) procedures 
is truly bizarre, and holds absolutely no relevance to cryonics. I was not 
discussing "the workability of general ECLS for a whole prospective population,"
I was pointing out, (yet again), that there is a very large number of people 
skilled in performing vascular cannulations and perfusion. Let's apply Harris' 
questions to vascular cannulations and perfusion, which is what we should be 
discussing, since those are the procedures needed to deliver cryonics washout 
and vitrification solutions. "Where is it (vascular cannulations and perfusion) 
done?" Just about on every street corner, in an urban setting, (any hospital 
offering open-heart procedures)!!! "How many patients have they done, (how many 
patients have been the recipients of successful vascular cannulations and 
perfusion procedures)?" MILLIONS!!! Hundreds of thousands, each year!


The bottom line is, delivering cryonics washout and vitrification solutions 
REQUIRES personnel capable of competently performing vascular cannulations and 
perfusion. Hundreds of thousands of vascular cannulations and perfusion 
procedures are routinely, and successfully, carried out, each year, for a 
variety of purposes, proving there are plenty of people capable of competently 
performing these procedures. Millions of dollars are being poured into cryonics 
organizations, each year, yet well-funded organizations, such as Alcor and 
Suspended Animation, persist in using mostly laymen, in attempts to perform 
these procedures.


THE REAL POINT IS: Given that perfusing patients with cryonics solutions is the 
SOLE PURPOSE of cryonics standby and surgical teams, at Alcor and Suspended 
Animation, (ALL the patients are automatically "selected" for these procedures, 
with the exception of the "straight freeze" patients), shouldn't these 
organizations have personnel capable of competently performing vascular 
cannulations and perfusion? If Alcor and/or SA are not going to provide 
competent personnel, for the procedures they market, they should offer up 
detailed descriptions of their true capabilities, and adjust their prices, 
accordingly. For them to charge $60K - $150K for people who are not capable of 
competently performing these procedures is obscene. If all they can promise to 
deliver, (in the way of standby/stabilization teams), is a group of laymen 
capable of packing people in ice, injecting meds into existing IV's and applying
chest compressions, then they need to make that abundantly clear in marketing 
their services.

Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=32734