X-Message-Number: 33370
From: 
Date: Mon, 28 Feb 2011 01:28:13 EST
Subject: Melody Maxim's Distorted Reality 5

Content-Language: en

 
Melody Maxim writes:   
Mike Darwin: "Your  remarks about unreliable and malfunctioning in-house 
fabricated circuits  certainly don't apply to my experience of nearly 25 

years. I have never had a  circuit fail - never. I have had an oxygenator fail,
but that is really the only  mechanical failure I've ever had on CPB. One 
qualification is that the Sarns  venous reservoir bags did not have a rigid, 
internal fenestrated intake line.  This meant that under high flow conditions 
the bottom of the bag around the  orifice feeding the pump would sometimes 
collapse and cut off flow. This problem  was remedied by switching to the 
Gish/Terumo bags."   
One of the key  figures in the perfusion group SA is said to be working 

with is a prominent  figure in the perfusion community. He's the co-author of a
book that can be  found in the lab coat pockets of a large percentage of 
clinical perfusionists,  and is required reading material for many perfusion 
students. At the risk of  being rude, I doubt his perfusionists need Mike's 
advice, regarding which  reservoir bags to use. I believe Mike's persistence 
in naming as many specific  perfusion devices he can, and remarking on 

things like "internal fenestrated  intake lines" to be a major distraction from
the REAL issues the amateurs  working in cryonics, or the people reading this 
forum, need to be concerned  with, (like the basics of maintaining proper 
perfusion pressures and preventing  air embolization). Given that SA starts 
with a known volume of solution, it  should be easy to determine, (even 
during a case), if the flow rate is  approximately accurate. For the washout 
procedure, would it really matter if the  flow were actually 3.2LPM, when the 
flow meter was reading 2.9LPM? For as long  as you have good patient pressures 
and no air is getting pumped to the patient,  the proper answer to that 
question would be a definitive, "No.""   
Mike Darwin: These  remarks are not so much rude as ignorant. I'm glad SA 
has such a fine  perfusionist. But, no matter how good this man is, he will 
almost certainly not  have expertise unique to and essential to proper 

extracorporeal management of  cryopatients. How could he? No patient presenting
for clinical CPB even  approximates the average cryopatient presenting for TBW 
and/or asanguineous  ECMO. Even within perfusion there are areas of 
specialization that require  additional knowledge and training: extended ECMO, 
emergency fem-fem CPB,  neonatal and pediatric CPB, and normothermic CPB, to 
name a few. What is so  extraordinary about the idea that cryonics should be 
the same? As just one small  example, Ms Maxim had no idea how or why 

conventional CPB flow meters worked, or  that they would not work in cryonics. 
That 
comparatively trivial lack of  knowledge resulted in the following (quoting 
Ms. Maxim):   
When the flow  transducer would not work with CI's solutions, I attempted 
to persuade Ben to  allow me to find another way to measure the flow. There 
are other ways, and I  felt the safety of the centrifugal pump, (it makes it 
virtually impossible to  pump air to the patient), far out-weighed the 

inconvenience of finding an  alternative for measuring flow. I did not try very
hard to convince Ben, because  I sensed he was uncomfortable with the pump, 
and I felt certain there was no way  for me to make him comfortable with it, 
in the three short days I would be  there. He seemed quite happy with the 
occlusive (roller) pump I had helped him  acquire, so I volunteered to 
purchase the centrifugal pump back from CI. I told  Ben I wanted to do some 

experiments with the pump, and I did, but the main  reason I wanted to buy the 
pump 
back from CI was that I did not want them to be  out $1,800 for a pump they 
purchased on my advice, but would not be using. I  even paid for them to 
ship it to me.  
To summarize, the  costs of this lack of existing knowledge were at least 
as follows:   
1) Time and effort  lost acquiring a pump that was not useable.  
2) Any time and  effort lost trying out others methods of determining flow 
that have already been  explored and found unworkable.  
3) Money expended  needlessly on the system and on shipping it to and fro.  
 
4) Loss of  credibility that results when others learn that these problems 
had already been  extensively explored in cryonics and that that information 
was readily  available, some of it on the Internet.  
5) Knowledge of new,  scientific/industrial ultrasonic flow meters that may 
well work for cryonics  applications (but which have not yet been tested).  
Melody Maxim writes:   
Mike Darwin: "One  last point I'd like to make is that it is important to 
consider the context of  the times. SA has, by any standards in cryonics, 
vast amounts of capital and  human resources. Most of the history of cryonics 
has been one of negligible  capitalization and in most of the world this is 
still the case. The SCPC system  is lovely, but the question is, is it 
affordable for most cryonics operations  not heavily financially subsidized?"  
Now, THAT'S a damn  good question. However, it's long been my opinion that, 
if we are able to  improve the quality of patient care in cryonics, the 

science will gain a wider  acceptance, and more money will come in. (Sort of an
"If you build it, they will  come," kind of thing.) SA has the funding to 
provide quality equipment and  qualified personnel to operate it. Would Mike 
have them remain in the dark ages  and rely on self-taught amateurs with 
makeshift equipment, just in case the  funds dry up? I think I have a better 
suggestion: SA could save hundreds of  thousands of dollars each year, by 
cutting their staff to two full-time people  managing a well-manned, 

well-maintained standby team of professionals. The  professionals would 
determine what 
equipment will be used, and if anything  needed to be built, it could be 
contracted out to reputable engineers who would  deliver the projects within a 
specified time- and price- range. The  professionals would be able to write 
their own case reports, so SA wouldn't have  to pay a science fiction writer 
to make them look like fools."   
Mike Darwin: I'm in  agreement with most of these sentiments, but not the 
idea that if you build it  they will come in the sense that cryonics will 

instantly or even soon be  transformed into a medical-professional undertaking.
Here's the irony: Ms Maxim  and many others took cryonics seriously enough 
to get involved because it  APPEARED that biomedically sound perfusion 

technology was actually being used by  some extant cryonics organizations. That
that appearance was even possible was  almost solely a result of a time in 
cryonics when such sound, medically-based  perfusion practices were in fact 
being used. When Jerry Leaf and I were no  longer present the patina of 
biomedical credibility was sustained, but NOT the  reality.  
That reality, when  it existed, used both professional medical personnel 
and in-house trained  personnel. These people were trained to do perfusion 

procedures of sharply  limited complexity to very high standards with safety as
the core goal. No, they  could not pump a clinical CPB case, just as a 
paramedic cannot manage a patient  in septic shock in the ICU. However a 

paramedic CAN successfully manage a  patient in septic shock long enough to get 
him 
to the hospital ED. Paramedics  are not made in a weekend and neither were 
the (very few) in-field CPB techs we  trained. In fact, NONE OF THEM WERE 
EVER USED; either Jerry or I did or  supervised every TBW done during our 

tenure at either Alcor or BPI. The primary  (and successful) use of the in-house
perfusionists we trained was to mind the  pump during dog research. This 
was a demanding and essential job which we could  not afford to pay 
professional perfusionist to do on a long term basis.   
In a broader sense  it IS true that if you build it they will come.' That 
sense is that IF you have  a medically sound practice of cryonics which is 
rational and evidence based,  then a few medical professionals will be 

attracted to cryonics and will not run  away in disgust at what they find. A few
of 
these people will stick around and  get involved. Cryonics was lucky that 
two such people stayed around and worked  to improve things DESPITE the 

horrible state it was in. The Chamberlains, Art  Quaife, Jerry Leaf, myself and
others are examples of this at different times in  different places and in 
different ways.  
Melody Maxim writes:   
Mike Darwin:  However, no amount of technology will protect you from 
incompetence and lack of  skill.  
I couldnt have said  it better, myself!"  
Mike Darwin: This  has been my point since at least 1978. Even very crude 
equipment can be using  with surprising safety and effectiveness if you have 
competent and experienced  personnel. Ive seen CPB done safely in the Third 
World using procedures and  equipment that would shock any Western 

perfusionist including using the same  circuit for 3 different patients (all 
with the 
same blood type and cross-match  compatibility) with no safety equipment 
and nothing to monitor CPB but a  manometer, an oximeter and pH meter (no 
blood gas equipment!).  


 Content-Type: text/html; charset="UTF-8"

[ AUTOMATICALLY SKIPPING HTML ENCODING! ] 

Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=33370