X-Message-Number: 30657
Date: Thu, 27 Mar 2008 20:02:40 -0500
From: Hagen <>
Subject: Re: CI's 81st Patient (my Dad)
I was very grateful to read Ben Best's comments on CI's 81si Patient regarding
his benefit from SA treatment. That man is (was) my Dad. Over the past few
months I have read about the controversy regarding SA's treatment of my father.
I hope this contribution from Ben can put issue to rest. While I agree the SA
report could have been much more accurate, I am satisfied with SA's service.
They were there when my Dad needed them. SA went to extraordinary lengths to be
in Green Bay when our family said good bye to my Dad. I was contact with SA
the evening of the event several times. They were respectful. They did not
pressure me to make a decision regarding their treatment. They contacted me and
asked if our family wanted them. I was not offended by the contact. Once I
said yes I was contacted several times by SA, but they needed to know certain
information. Perhaps the best opportunity for improvement by SA and CI is this:
Those who are not cryonisists do not unders
tand the
lack of emotion and matter of fact-of-fact attitude towards passing. My Dad had
somewhat prepared me for this event but it is still by far the longest, worst
day of my life. I do not regret SA involvement one bit. Obviously I would
have preferred perfect treatment with no possibility of anything going wrong,
but given the situation SA was faced with I am well satisfied. Lastly I need to
publicly compliment Kelly Kingston of SA. She was very compassionate &
professional.
Paul T. Hagen
CryoNet - Thu 27 Mar 2008
#30652: CI's 81st Patient Benefited from SA Treatment (Part I) [benbest]
#30653: CI's 81st Patient Benefited from SA Treatment (Part II) [benbest]
#30654: health benefits of red grape juice [oberon]
3 message(s) removed from digest due to low reputation.
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Message #30652
Date: Wed, 26 Mar 2008 23:12:22 -0400
From:
Subject: CI's 81st Patient Benefited from SA Treatment (Part I)
The Cryonics Institutes 81st Patient
Greatly Benefited from Suspended Animation Treatment
(Part I)
Melody Maxim wrote:
> As Ben Best knows, I think "nothing" would have better than
> "something," in regard to the services provided to CI-81, by SA. As
> a professional perfusionist, I believe the SA report and addendum
> clearly indicate the over-pressurization of the patient, and a
> failure to administer the proper medications.
I repeat and will try to explain with greater clarity
why I believe that the evidence points strongly to the
conclusion that the Cryonics Institute's 81st patient was
greatly benefited -- not harmed -- by the transport
treatment he received from Suspended Animation, Inc.
The patient required no standby because the moment of legal
death was determined by when life support was removed. This
allowed Suspended Animation to immediately begin cool-down
and CardioPulmonary Support (CPS). The patient was given
chest compressions from the time life support was removed to
the time his blood was washed-out and replaced with organ
preservation solution. The continuous chest compressions
circulated blood to the patient's tissues while his metabolic
rate was being reduced by the ice-bath cooling. Under these
conditions there should be no reperfusion injury when the
blood was washed-out.
If the patient had only received the services of a funeral
director he would have only received a few chest compressions
to circulate heparin, cooling (with ice bags) would have been
far less efficient and there would have been no organ
preservation solution/blood replacement to preserve his
tissues. Any attempt by the funeral director to do a blood
washout without continuous CPS and ice-bath cooling would
have certainly resulted in reperfusion injury.
By the use of an ice bath, CardioPulmonary Support (CPS)
and an ATP the patient was cooled to below 10oC in about half
the time such cooling could have been achieved by a funeral
director using ice bags. Moreover, CPS during the cooling period
meant that tissues could remain viable in a way that would
not have been possible without CPS. Administration of
citrate, epinephrine, streptokinase, vasopressin and antioxidants
in addition to the usual heparin eliminated clots (except
in the region of the cerebral hemorrhage), increased circulatory
capacity and reduced ischemic damage. Blood replacement with
organ preservation solution in a timely manner reduced the cold
ischemic damage the patient would have suffered during shipment
in ice to CI's Michigan funeral home where vitrification
perfusion was performed.
It is commonly noted that metabolic rate is halved for every
10oC drop in temperature. But the reduction of lipid peroxidation
by cooling is greater than the reduction of metabolic rate, and
the greatest benefits occur for rapid cooling in the initial
stages. Experiments on gerbils indicate that a drop in temperature
from 37oC to 31oC nearly triples the amount of time that neurons
can tolerate ischemia [CRITICAL CARE MEDICINE; Takeda,Y;
31(1):255-260 (2003)]. Experiments with dogs that have been quickly
cooled with blood washout solution have shown that cooling from 30oC
to 10oC can extend the tolerable period of cardiac arrest without
neurological damage from 5 minutes to as much as 120 minutes
[CRITICAL CARE MEDICINE; Behringer,W; 31(5):1523-1531 (2003)].
(continuted in Part II)
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Message #30653
Date: Wed, 26 Mar 2008 23:55:41 -0400
From:
Subject: CI's 81st Patient Benefited from SA Treatment (Part II)
The Cryonics Institutes 81st Patient
Greatly Benefited from Suspended Animation Treatment
(Part II, continued from Part I)
The case for the claim that the patient experienced harm rather
than benefit from Suspended Animation is based on the following
lines from the case report written by Suspended Animation:
> "Two minutes later he [the funeral director] exclaimed in surprise
> as he made an incision and found blood spurting onto
> him under pressure from the cannula that was already attached to
> the ATP on the arterial side. He was heard to ask if the
> ATP pump was running. The Third Team Member confirmed that it was.?
These statements are based on interpretations of case notes
and voice recording, which contradict information in both the
case notes and what the funeral director told me. If I make an
explicit statement of the interpretation that the above lines might
imply, it would be:
"The ATP was connected to the femoral artery and was creating
high pressure in the patient's blood vessels which resulted
in blood shooting out of the femoral vein at the instant that
the funeral director made his incision."
For this statement to be true, the ATP would have to have been
switched-on at the very instant that the funeral director made
his cut. If the ATP had been pumping into the arterial side even
five seconds before the funeral director made his incision, the
blood vessels would have burst before he made his incision.
Additionally, blood would have continued spurting until the ATP
was shut-off. But nowhere is there a description of more than
one spurt or of an effort to turn-off the ATP to stop gushing.
In the unlikely event that the ATP had been switched-on at
the instant that the incision was made, and then immediately
switched-off, the pressure relief of the spurt would have
prevented blood vessel damage.
Many contradictions can be found among the many sources of
evidence for what happened in this case, but little of that
evidence points to vascular damage. The case notes of one
team member states that chest compressions were being given
when the spurt occurred, whereas the team member reportedly
giving the compressions states in his notes that he was not
giving compressions at the time of the incision.
When I spoke to the funeral director about the case he
provided three especially salient comments:
(1) the spurt was from the femoral vein (not the artery)
(2) the spurt occurred when he was inserting the cannula
(not when he was making an incision)
(3) the ATP could not have caused the spurt because it was
not "hooked up" when the spurt occurred
To choose to believe only the first statement while
rejecting the second and third on the grounds that I spoke
to the funeral director several months after the event is
hard to justify. The fact that there was only one spurt
rather than a continuous surge is hard to reconcile with
the idea that the ATP was "hooked up" and running. Volume
displacement by the insertion of a large cannula into a
vein that had already been cut could explain a spurt.
Possibly even the team member who denied giving chest
compressions at that moment had actually done so.
It is certainly to be expected that the ATP would run
before it was "hooked up" as standard procedure to remove
bubbles from the circuit before beginning perfusion.
I am making what seems to me to be the most reasonable
interpretation of contradictory reports given by others
concerning an event I did not witness. During the vitrification
perfusion in Michigan there was no evidence that vascular
damage had been inflicted by Suspended Animation
-- quite the opposite. There was good flow on the left side,
with clear fluid emerging from the left jugular. There was
initially no flow on the right side until a clot was
dislodged that was undoubtedly associated with the
hemorrhagic stroke that the patient suffered on the right
side. A clot of that magnitude due to a stroke would not
be expected to be dislodged by the streptokinase
administered by Suspended Animation. Streptokinase can
surround and dissolve small clots, but could not be
expected to penetrate into a region where clotting is
so great that there is no flow. Without flow the
streptokinase could not even come into contact with
the clot. The fact that the clot would be dislodged by
the vitrification perfusion and not by the washout is
not surprising in light of the high osmolality of
cryoprotectants.
How could such good vitrification perfusion have been
possible on the left side if blood vessels had been
damaged by excessive pressure at the time of the
wash-out?
It is harmful to potential patients and
unsubstantiated to claim that Suspended Animation
is likely to cause harm rather than great benefit.
I would not disagree that many things could and
should have been better. I would not have written
the case report that Suspended Animation wrote without
at least attempting to speak to the funeral director.
The failure to send a full team on the grounds that
the patient was not fully funded has reflected
negatively on perceptions of Suspended Animation
deployment.
I have no doubt that for future patients who are
fully funded that Suspended Animation will send a
full team which includes a paramedic or other medical
professional. Kelly Kingston is completing an EMT
training. Suspended Animation has been having regular
and thorough practice/training sessions in the last
year. Not only did the 81st CI patient receive great
benefit from Suspended Animation, but future patients
can expect to receive even greater benefit.
-- Ben Best
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