X-Message-Number: 18954
From: 
Date: Tue, 23 Apr 2002 00:11:53 EDT
Subject: Crossing Jordan

In a message dated 4/22/02 2:01:42 AM Pacific Daylight Time, Driven From The 
Pack writes:

> Yahoo truncated the end of your message, but I infer
>  that a cryopatient was being autopsied?

No, this is not correct. It was a discussion mostly about the poor quality of 
the show and the possibilities for really interesting and gruesome drama 
"ripped from the headlines" that people seem to enjoy watching on TV these 
days. Examples are Fear Factor, Law and Order, and the graphic images to be 
had on the Discovery Health Channel's programs such as "Operation," to name 
only one of many. Some of these programs like Law and Order and "Operation" 
are quite well done. In the case of the former there is some semblance of 
technical accuracy and in the case of the latter the technical and medical 
detail are usually excellent and highly accurate. 

>  You have mentioned before that we cryos overestimate
>  our chances of a good death, and autopsy would
>  defintely be a bad death.  However, as a counter to
>  your pessimism in that area, the bulk of your
>  experience comes from 15-25 years ago (yes?), when the
>  percentage of autopsies was greater....

No, I stopped providing active services in 1998-9. However, I have also kept 
close watch on the type of cases being done over the past decade. This is 
largely only possible for Alcor who reports meaningful basic case data. CI 
usually simply states that "no information will be released due to family 
requests for privacy." FYI, release of technical data does not have to 
compromise family privacy, nor does publication of statistics showing warm 
and cold ischemic times, time postmortem until some kind of care was given, 
cause and mode of death, and percentage of patients autopsied, or subjected 
to long delays because they were Coroner or ME cases (even if not autopsied).

The numbers remain about as I've said. 

Here is a recent partial case break down from Alcor the date of the first 
case is the start of the period covered through the present, based on data I 
have (which is probably not complete):

A-1573: AT NEED. Liver failure secondary to advanced cancer. Prompt CPS and 
stabilization. CPA perfusion reported to have gone well. Overseas patient 
transported to US on dry ice.

* A-1261: MEMBER. Unwitnessed arrest secondary to disseminated cancer. No 
onsite stabilization. Poorly packed in ice by local mortician. Arrived at 
facility at ~+10 C @ ~30 hours postmortem. Abdominal decomposition underway. 
CPA perfusion achieved to target CPA effluent concentration.

* A-1216: MEMBER. Elderly gentleman who suffered massive stroke. Brain dead 
or minimal brain EEG activity with clinical signs of brain death (no flow to 
brain) for ~24 hours prior to arrest. Prolonged post-arrest normothermic 
ischemia. CPA perfusion achieved to target effluent concentration.

* A-1502: MEMBER. Auto accident victim with massive head trauma including 
basal skull fracture. Coroner's case. Heparinized promptly postmortem. 
Released without autopsy. 30+ hour delay to arrival at Alcor due to logistic 
constraints: airline schedules, weather, suddenness of death. Problematic CPA 
perfusion (good under circumstances: target CPA concentration in effluent 
reached).

A-1705: MEMBER. Hospice death from cancer. Relocated to Phoenix. Witnessed 
arrest with prompt stabilization. Good CPA perfusion.

A-1756: MEMBER. Home hospice cancer patient. Developed massive airway 
occlusive bleeding with ~4 minutes of start of CPS. Ice bag cooled. ~ 3 hours 
of ischemia at ~30 degrees C (37 C is normal body temperature). Good CPA 
perfusion.

* A-1894: MEMBER. Patient with long history of end stage Alzheimer's, averbal 
and uncommunicative for several years before death, massive loss of 
neocortical structure, cortical surface atypical in appearance on opening 
burr holes. Two hours of measured near normothermic ischemia (~27 C) before 
perfusion cooling initiated. Primary, structure-obliterative end stage brain 
disease. Good CPA perfusion.

A-1876: RECENT MEMBER. Hospital patient. Prompt postmortem CPS but effective 
ventilation not possible due to lung disease and pulmonary edema, promptly 
medicated, rapidly cooled, blood washed out and transported via private jet 
aircraft. CPA perfusion started ~7 hours post arrest. Good CPA perfusion.

* A-1300: MEMBER. Sudden Cardiac Death (SCD) CPS and stabilization not 
possible. Unwitnessed arrest with prolonged (unknown) down time. Problematic 
cryoprotective perfusion.

* A-1891: MEMBER. SCD. Unwitnessed sudden cardiac death. Found in rigor by 
next of kin. Coroner's case but released with autopsy (thanks to Bill 
Falloon). Effective postmortem CPS and stabilization not possible. CPA 
perfusion begun ~9-12 hours after arrest. Problematic CPA perfusion with 
superficial and cerebral edema.

**A-1346 : MEMBER. Businessman killed in WTC attacks. Remains not recovered.

Looking at the above ten cases which span the time from ~April of 2000 
through the present we find that 60% of them had *very* suboptimum 
presentations through no fault of the cryonics organization. A-1261 could 
have gotten better support bud had family unwilling to inform the patient or 
the cryonics organization of impending death. This case was further 
complicated by bureaucratic problems related to issuance of the Death 
Certificate. There were two cases of Sudden Cardiac Death (SCD) or 20%, about 
the statistical average for a population with mean age of 45 years. There 
were two accidental deaths one resulting in complete obliteration of the 
remains. In the other case only a very sympathetic local Coroner did not 
perform an autopsy. This case can truly be classed as accidental in that the 
patient was walking her dog when a car veered off the road and struck her. 
A-1894 suffered a massive stroke as a result of an embolic event secondary to 
mitral valve replacement ~ 1 year before. Patient A-1894 had end-stage 
Alzheimer's disease with probably obliteration of much identity-critical 
brain structure. 

One reason these statistics are as bad (and thus perhaps as realistic) as 
they are is that during much of this period Alcor refused most near need 
cases. Ironically, near need cases act as a filter which allow for advanced 
preparation, intensive antemortem education of the patient and family, and 
typically involve patients without advanced primary brain disease.

These dismal numbers also reflect the reality that, due to modern medicine 
and sanitation, the majority of the population is living into old age where 
SCD or primary brain disease such as stroke or Alzheimer's become the 
predominant causes of death. The accidental death rate may be ranked as 
artificially high for this small sample since one case (10%) involved a 
terrorist act.

Still, these numbers should be sobering, and far from flying in the face of 
conclusions I'd reached before, they amplify them.

By statistical reckoning over a longer time course the numbers should break 
out about as follows:

 ~35% of patients will die under very suboptimal conditions which involve long 
time delays.

 ~30% of patients will die from primary brain disease, other brain 
obliterative causes of death (fire, natural disaster, etc.) or be subjected 
to autopsy.

 ~20% of patients will die under reasonably good conditions and achieve 
reasonably good cryopreservation.

 ~10% of patients will die under optimum conditions and receive 
cryopreservation under what is now considered ideal circumstances.

Improvements in technology can theoretically improve these adverse numbers. 
Detecting SCD rapidly by something like the Digital Angel, proactively 
dealing with bureaucratic obstacles, and better education of members in 
preparation for and execution of their medical care choices would all help. 
However, some people will still be hit by cars, or die suddenly without being 
found or treated promptly. These are realities every cryonics member should 
face and work hard to try to address. 

As a footnote, CryoCare member John Perry might also be included in the above 
statistics since, had he died in a way that would have permitted it, he would 
have been cryopreserved at Alcor:

John Perry: CC MEMBER: Police Officer killed in WTC attacks. Remains 
recovered ~6 months after the incident. Not cryopreserved due to family 
objections and influence with NYC ME.


>  Regarding the percentage of hospital deaths autopsied,
>  here is a quote from some online source:
>  
>  "Consider that in 1945 half of all deaths were
>  routinely autopsied: today, that number is closer to
>  10 percent. This morbid art --practiced by humans
>  since 300 B.C. and modernized by German scientists in
>  the mid-1800s--is itself dying. "
>  
>  So, I think you are more pessimistic, perhaps, than is
>  warranted (feel free to correct me...). 

Hospital deaths are misleading. Many people die suddenly out of hospital or 
die in hospital using "brain death" criteria or are effectively brain dead 24 
hours or more before they are pronounced legally dead. Roughly 25% of people 
die outside of hospital from accident, suicide, or sudden cardiac death. We 
must now also add terrorist acts to this list. These numbers have not changed 
and they cause direct trauma, medicolegal delay and autopsy. See detailed 
discussion above.
  
>  Also, there have not been that many cryos under
>  contract who have died, and been frozen or otherwise,
>  and a significant number of them were **suicides**.  I
>  think the high percent of cryos who suicided unduly
>  influences the numbers and your opinion....

There are a disproportionate number of suicide deaths in cryonics compared to 
those in the general population. However, the number is not overwhelming. I 
have personally dealt with only two such cases and know of perhaps half a 
dozen more. Several of these people were not cryopreserved, but I still count 
them.

Mike Darwin

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