X-Message-Number: 33387
From: 
Date: Mon, 28 Feb 2011 02:59:33 EST
Subject: Melody Maxim's  Distorted Reality 20

Mike: "Ben did not like the fact  that this system was too big; it could 
not fit in the tiny prep room of the  cranky mortician CI uses. I told him 
that an integrated cart could be fabricated  to replace the mortician's prep 
table that would include all of these things and  more... The answer was still 
'no': it was all too complicated..."   
I received much the same answers..."Too big, too complicated."  While I 
would certainly have liked to have seen more of my perfusion suggestions  

implemented, I understood that CI had their limitations. If you have to do your
perfusion at a mortuary, and the mortician will only allow you a certain 
amount  of space that is what you have to live with. It's not like there's a 
funeral  director willing to participate in cryonics on every street corner. 
And, if you  can't afford a full-time perfusionist, or standby perfusion 
fees, you can't  afford it.  
Mike: So, Ben asked me to set CI up with what he saw as a very  simple 

circuit that basically consisted of the arterial leg of a standard CPB  AV-loop.
I told him I would do this ONLY if he would accept the (free) training  and 
teaching that MUST accompany this. He refused. I explained that the very  
simple (indeed crude) system CI used had one great advantage: it's simplicity 
 reduced the chance of catastrophic errors. I told him bluntly and 
repeatedly  that the instant large surface area devices are introduced into a 
circuit  enormous knowledge is PRESUMED about how they will behave and how to 
de-bubble  them. A simple glass bubble trap would be infinitely better for CI 
than even a  good auto-venting arterial filter - absent extensive and 
VALIDATED training on  how to use such equipment.  
I cannot even begin to explain how strongly I disagree with this,  as a 

trained and experienced perfusionist "with a working knowledge of perfusion  at
Board Certification level," and as someone who has watched the employees of 
 SA use both a bubble trap and an arterial filter. They had difficulty 
priming  the bubble trap, and filled it with air almost every time they turned 
the pump  off, and then didn't know how to remove the air, in order to resume 
flow. They  didn't have these problems, once I changed to an arterial 
filter. The arterial  filters are much easier to use. They come preassembled, 
with a bypass loop and a  purge line that includes a one-way valve. In 

addition, not only do they protect  against air, but they remove particulate 
matter. 
 
Mike: "Instead, he went out and hired a perfusionist to do what he  wanted 
done. I'm sure this person did the best they could under the  circumstances. 
But, what the expert forgot was that a perfusionist is not made  in a day, 
or a week, or a year, and that hundreds of lab hours and clinical  hours are 
clocked before they are turned loose - even as an intern on a human  
patient. During those 'invisible' hours the perfusionist soaks up an  
'instinctive' knowledge of the craft."  
Mike seems to mistakenly assume I didn't make certain suggestions,  (some 
the same as his). In addition, Ben didn't hire me to "do what he wanted  
done," he asked for my professional opinions and suggestions, and some basic  
instruction, then he made decisions, based on CI's "comfort zone." It was  
ridiculous, and extremely presumptuous, for Mike to assume I forgot "a  

perfusionist is not made in a day, or a week, or a year, and that hundreds of  
lab 
hours and clinical hours are clocked before they are turned loose." I'm sure 
 I know that much better than he does. A perfusionist isn't made in a 
couple of  decades, by experimenting with perfusion equipment in cryonics, and 
relatively  little actual clinical experience, either. I'm quite sure Ben 
would confirm that  I must have said something akin to, "I can never teach you 
what you need to  know, about perfusion, in these three days," dozens of 
times, while I was there.   
Mike: "The result was that CI pumped air on the first patient on  whom they 
used their 'new and improved circuit' which was, more or less, exactly  WHY 
I told Ben I refused to do as he asked. CI returned to a  
'simpler'circuit..."  
CI pumping air was not the result of consulting with a  perfusionist, or a 
"new and improved circuit" which was minimally changed from  what they had 
before. I've been told it was the result of someone not being  attentive to 
the reservoir, and to the introduction of a large amount of bubbles  while 
pouring additional amounts of solution into the reservoir. I've also been  
told massive amounts of air get pumped in a very large percentage of cryonics  
cases, while this is an EXTREMELY RARE, (virtually unheard of, in this day 
and  age), occurrence in conventional medicine, where professional 

perfusionists are  used. Incidents like this are a result of amateurs performing
perfusion, NOT a  result of consulting with professionals. Whether you have a 
bubble trap or an  arterial filter, when introducing large amounts of air into 
the circuit, you  will, at some point, exceed the amount of air the device 
can handle. "LESSON  ONE" for perfusionists is "Don't pump air," (in other 
words, "ALWAYS WATCH THE  RESERVOIR"). In my opinion, for cryonics, "LESSON 
ONE," in regard to perfusion  should be adapted to "KEEP THE RESERVOIR FULL. 
(In conventional medicine, this  can't be done, because it's important to 
hemodilute the patient as little as  possible, but this is not the case in 
cryonics.) When using large volumes of  solution, such as is the case in 
cryonics, there are ways to introduce  additional solution to the reservoir, 

without introducing air. I discussed at  least two methods, with Ben, so I won't
go into the technical details, here.   
Sigh. Yes, I know all this. And I could foresee it and I did. But  you have 
yet to explain why this happened at CI only after they got a new  circuit? 
Why was the reservoir not baffled, or at a minimum why was this not  done 
(these are instructions written 30 years ago for emergency (expedient)  
perfusion equipment):  
4.0 Set-Up of the Circuit for Cryoprotective Perfusion:   
4.1 The circuit consists of a minimum 5-liter reservoir with a  bottom 

outlet (10 liters is preferred). TURN THE PUMP OFF AND CLAMOP THE LINES  TO THE
PATIENT WHEN FILLING OR REFILLING THE RESERVOIR! The reservoir should be  
filled, if possible, using a funnel with a short length of tubing attached. 
The  end of the tubing can be positioned below the liquid surface when adding  
additional perfusate. This will reduce the amount of air introduced into 
the  perfusate when additional volume is added. The tubing between the funnel 
and  reservoir is clamped when the funnel is first filled and air is purged 
from as  much of the line as possible. The clamp is then slowly released 
allowing air to  be displaced as filling is continued. One reason it is 
desirable to have a  larger reservoir is that it reduces the number of 

interruptions required in  order to top-up or change cryoprotectant 
concentration.   
The reservoir should be wrapped in some kind of insulating material  if 
possible; a small blanket or a number of turns of fabric will do.   
You conclude:  
I've taken more time with this than I wanted to, and now I'm pretty  much 
done with this discussion, other than to reiterate that I think it is  

extremely unproductive for Mike Darwin to discourage the use of professionals,
all the while demanding a professional level of competence. Cryonics is going 
no  where fast, for so long as the community is encouraged to shun medical  
professionals.  
--Melody  
Yet again, I have not done this; what I have done is to realize  that 
existing cryonics organizations will misuse professionals; seeking them out  

selectively and using their input equally selectively and without acquiring the
needed knowledge base and skills to truly address the problems. 

Professionals  (mostly unsuspecting) who get suckered into this relationship are
the 
ones who  get hurt; the cryonics people just keep trucking on, indifferent to 
the misery  they have caused, the iatrogenesis they have created, or the 
patients they have  harmed. They get away with it because cryonicists believe 
time will heal all  wounds and overcome all stupidity - and mostly because 
the patients cannot  scream, or bleed, or otherwise show objective signs of 
the injury they have  suffered.  
--Mike Darwin  


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