Computerized Perfusion Circuits and other Equipment

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Computerized Perfusion Circuits and Other Equipment
July 8 2007 at 11:32 AM Melody Maxim (Login melmax)
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I think one of the greatest obstacles to cryonics organizations has been a lack of information regarding existing equipment, especially the equipment used in heart surgery, which uses perfusion technology, the backbone of the washout and vitrification procedures. The recent issue of Alcor's magazine calls to mind a battle I had only just begun to fight, at SA. "Computerized Perfusion Circuits" have existed for decades, they are called "Heart-Lung Machines." I'm just wondering if anyone has ever told Alcor there is existing equipment they can build on, for their "Advanced Cryoprotective Perfusion System (ACPS)," and I'm interested in dispersing this information to all people and organizations working toward the advancement of cryonics.

Heart lung machines generally consist of four, or five, pumps and a computer on a rolling base. They can monitor flows, pressures, temperatures, and reservoir level. They can also monitor and protect against air emboli. When air is detected in a line, the machine automatically clamps the line and turns off the pump, preventing air from reaching the patient. Some of these machines also chart data. The only thing I can think of that is missing, for cryonics purposes, is monitoring of the concentration of the vitrification solution.

These machines are expensive, (I haven't priced one in many years, but I would guess in the neighborhood of $100,000 for one with quite a few "bells and whistles"), but certainly not out of range for SA. Large heart centers frequently update their equipment, and used machines can be had for a reasonable price. I suggested this approach to both Charles and Saul. Charles indicated cryonics needed something else, (and I'm sure he would be willing to hang out for a few years designing and building it), and Saul seemed extremely interested. Unfortunately, I didn't stay around long enough to make further recommendations because, after the cooldown box incident, it didn't seem to me that we were ever going to be able to do projects without Charles' influence.

I have a more detailed report on this topic, which I will post on the web site I am constructing. I hope to have the first pages up before the end of the month, maybe much sooner.


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Finance Department
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More fresh ideas - great!
July 8 2007, 11:56 AM

Melody, I hope the fresh ideas you are bringing to cryonics are not wasted on merely my and George's appreciation, as we are not the prime movers who should be considering them. I hope those people also are.

But, let's see about this $100K machine -- Kent or Faloon could just write a check for one. This will probably occur before one of them needs SA's services.

Alcor could do another "matching grant" beg program, instead of first finding the waste already in their organization and redirecting resources to things of better use for the members' dues money.

Maybe Trans Time will get one.

What am I saying .. ack .. I should have more coffee before I write these things.

FD



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filterpatrol
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Not knowing what you don't know
July 8 2007, 3:32 PM

Melody wrote:

"I think one of the greatest obstacles to cryonics organizations has been a lack of information regarding existing equipment"

I think one of the greatest obstacles to good discussion in this forum has been your lack of information regarding existing cryonics procedures, history of procedures, and why things are done the way they are. While as a newcomer this is understandable, your lack appreciation for this obstacle, and rush to criticize others without adequate background knowledge, is what is "burning bridges" and drawing fire from people like Steve Harris.

Look on this page

http://www.alcor.org/AtWork/p2facility.html

at the photograph labeled "Perfusion Equipment". You will in fact see a bank of medical heart-lung machine roller pumps, supplemented with extra equipment.

However cryonics needs many more things than just what heart-lung machines can do. Heart-lung machines maintain a prescribed flow rate, not a prescribed perfusion pressure. Heart-lung machines don't measure and add cryoprotectant. Heart-lung machines don't control perfusion temperature according to complicated rules that depend on cryoprotectant concentration. There is nothing off the shelf that does all that stuff, which is why cryonics organizations have to do complex custom engineering to make them happen.

If you want to maximize the signal-to-noise ratio of your contributions to the cryonics community, a bit more asking and less telling would be in order. Otherwise you assume too much that isn't correct.


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Melody Maxim
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Re: Not knowing what you don't know
July 8 2007, 4:50 PM

Hello Charles...

FILTERPATROL: "Heart-lung machines maintain a prescribed flow rate, not a prescribed perfusion pressure."

Are you sure??? And, what is the "prescribed perfusion pressure" for cryonics purposes? Are any of the RUPs at SA familiar with this information? How often has the desirable range of pressure been maintainable in cryonics cases?

FILTERPATROL: "Heart-lung machines don't measure and add cryoprotectant."

I've already said they don't measure the concentration of the cryoprotectant, but perhaps they could be programmed to.

As for the image you linked to, five roller pumps do not a heart-lung machine make.

All I'm asking is, why not at least look at, and consider building on, systems that already monitor several of the desired parameters, protect against air emboli and high pressures, and record data? Maybe Alcor has done this and decided against it. Or, maybe no one has ever explained to them all that the most recent heart-lung machines are capable of doing. I don't know. If you will read my message, I was wondering if they had considered this route, nothing more.

Personally, I don't think the vitrification perfusion process can be as automated as people in cryonics seem to think it can be. If it were so, someone would have done the same for heart surgery, with every patient getting specific flow rates at certain temperatures, and the concentration of drugs automatically applied to maintain certain pressures, levels of anesthesia, etc., a long time ago. It just doesn't work out that way, for dozens of reasons. Patients will arrive in a wide range of conditions and each case, while fundamentally the same, will be unique. You need people who know what they are doing, not machines programmed to deliver the same, exact protocol to every patient.


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filterpatrol
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Computer control
July 8 2007, 6:38 PM

MELODY: "FILTERPATROL: "Heart-lung machines maintain a prescribed flow rate, not a prescribed perfusion pressure."

Are you sure??? And, what is the "prescribed perfusion pressure" for cryonics purposes? Are any of the RUPs at SA familiar with this information?"

SA doesn't do cryoprotectant perfusion.

MELODY: "How often has the desirable range of pressure been maintainable in cryonics cases?"

How often has gravity been used to set an arterial pressure? That's the only way to reliably maintain a set perfusion pressure without automated feedback control. Having a perfusionist sit and change pump speeds in response to every change in vascular resistance or perfusate viscosity to maintain a fixed arterial pressure is both unreliable and a waste of human attention.

MELODY: "All I'm asking is, why not at least look at, and consider building on, systems that already monitor several of the desired parameters, protect against air emboli and high pressures, and record data? Maybe Alcor has done this and decided against it."

Maybe they've done it and decided that the pumps are the most useful part of a heart-lung machine for cryoprotectant perfusion.

MELODY: "Personally, I don't think the vitrification perfusion process can be as automated as people in cryonics seem to think it can be. If it were so, someone would have done the same for heart surgery, with every patient getting specific flow rates at certain temperatures, and the concentration of drugs automatically applied to maintain certain pressures, levels of anesthesia, etc., a long time ago. It just doesn't work out that way, for dozens of reasons. Patients will arrive in a wide range of conditions and each case, while fundamentally the same, will be unique. You need people who know what they are doing, not machines programmed to deliver the same, exact protocol to every patient."

The object of computer-controlled cryoprotectant perfusion is not to make perfusion brainless replication. It's to give direct control over the most important control variables in a cryoprotectant perfusion, which are pressure, temperature, and concentration. Otherwise people waste their time constantly adjusting flows to maintain target pressure as viscosity increases (something that doesn't happen in clinical perfusion), or adjusting coolant to maintain a target perfusion temperature, or adjusting gradient pumps to control concentration. The need for such nonsense was done away with 20 years in cryopreservation research with the advent of computer-controlled perfusion, and it's high time that cryonics, which purports to use the technology of organ cryopreservation, did the same thing.


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Melody Maxim
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Re: Computer control
July 9 2007, 8:49 AM

FILTERPATROL: SA doesn't do cryoprotectant perfusion.

No, but they claim to be working toward it, and I started this thread about a perfusion system that might be of use in developing that technology, not SA, per se. Take a look at SA’s website. On the home page, you will find: “Our research projects include a portable liquid ventilation system to enhance rapid cooling in the field, custom modification of advanced rescue and transport vehicles, and equipment to enable low-temperature human vitrification.” This establishes two things: They are claiming to be working on equipment for cryoprotectant perfusion, and all of their “research” is geared toward developing Platt designs. (I don’t know how they call it “research” when Platt refuses to even look at existing equipment before he starts building.)

Go over to their page on vitrification and look under “4. Cryoprotective Perfusion,” on the right-hand side of the page. You will read, “In an operating room at the cryonics facility, a cryoprotectant (ideally a vitrification solution) is introduced to protect against injury associated with freezing.” If you ask me, that statement is possibly misleading, as SA neglects to point out their operating room is not functional. Even “3. Transport” doesn’t make clear that they have to take the patient to CI or Alcor for this procedure.

FILTERPATROL: How often has gravity been used to set an arterial pressure? That's the only way to reliably maintain a set perfusion pressure without automated feedback control.

You obviously don't know what you are talking about. Perfusionists do not use gravity to set arterial pressures, they use flow rates and drugs.

FILTERPATROL: “Having a perfusionist sit and change pump speeds in response to every change in vascular resistance or perfusate viscosity to maintain a fixed arterial pressure is both unreliable and a waste of human attention.”

As a perfusionist with extensive surgical experience, I strongly disagree. Having someone attentive to, and responsive to, changes in circuit volume is invaluable. I won’t bother to educate you as to the many reasons why. As I’ve already stated, it’s obvious you don’t know what you are talking about.

FILTERPATROL: Maybe (Alcor has) decided that the pumps are the most useful part of a heart-lung machine for cryoprotectant perfusion.

And maybe they haven’t, I happen to know this is not exactly the case. Regardless,buying a new heart-lung machine and building a stand-alone machine to monitor the concentration of cryoprotectant and dose accordingly, would bring SA right up to speed with Alcor, in regard to cryoprotectant perfusion. What am I saying??!!! SA isn’t even capable of doing what they set out to do, (provide the best standby, stabilization and transport), much less anything more advanced. It should be easy for everyone to see this, just by looking at SA’s “Employees” page and reviewing what little information we have about their last case.

FILTERPATROL: “The need for such nonsense was done away with 20 years in cryopreservation research with the advent of computer-controlled perfusion, and it's high time that cryonics, which purports to use the technology of organ cryopreservation, did the same thing.”

A single organ is not the same as an entire patient. If you rely on computers too much, you’ll end up with a room full of people who don’t know what is going on, or how to respond if they do happen to realize something is wrong. For example, can a person who is incapable of paying attention to a four-liter reservoir be relied on to realize the numbers on a screen indicate the patient is losing volume internally?


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filterpatrol
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Knowing what one is talking about
July 10 2007, 3:01 AM

"You obviously don't know what you are talking about."

Oh but I most assuredly do know what I'm talking about. So far your attitude has alienated Charles Platt (not hard), Steve Harris (harder), and now me (harder still). I'm more patient than either of them, but this discussion is obviously going nowhere. Terminating it is no loss for me because I already know a clinical perfusionist with a better appreciation for where his knowledge ends and other's begins. Terminating it is no loss for you because you already believe you know all that you need to know. Good luck.


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Anonymous
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Re: Knowing what one is talking about
July 10 2007, 5:19 AM

For filterpatrol to end the dialogue like that is very rude.


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Finance Department
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What are we talking about!
July 10 2007, 6:13 PM

Rude? Maybe not the smoothest language, but after a while an employer in some way ends a discussion of whether a person fits into a particular employment situation or not - you don't just keep talking about it on and on.

That, it would appear to me, is what was the scenario of filterpatrol's post above, rather than being merely a discussion of the pros and cons of certain procedures and equipment.

All that aside, I do hope that Melody finds a way in the not so distant future to put her obviously sophisticated skills and ideas to practical use for cryonics. And I think it is a shame it apparently will not be with SA, which is in obvious need of talent. So it goes.


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Steve Harris
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Knowing what you know
July 13 2007, 2:23 AM

FD: Rude? Maybe not the smoothest language, but after a while an employer in some way ends a discussion of whether a person fits into a particular employment situation or not - you don't just keep talking about it on and on.

That, it would appear to me, is what was the scenario of filterpatrol's post above, rather than being merely a discussion of the pros and cons of certain procedures and equipment.

COMMENT:Yes, but there's also that old issue of knowing what one is talking about:
==============
FILTERPATROL: How often has gravity been used to set an arterial pressure? That's the only way to reliably maintain a set perfusion pressure without automated feedback control.

Maxim: You obviously don't know what you are talking about. Perfusionists do not use gravity to set arterial pressures, they use flow rates and drugs.
================


COMMENT: Gravity has been used to set pressures in many cryobiological organ preservations, which resemble cryonics far more than does mildly hypothermic perfusion.

Actually, a certain amount of venous suction by gravity drainage (or else active suction by different mechanisms) does play a role is many, perhaps most, modern perfusion cases. If you can't control venous pressures, you can't control arterial pressures unless you're willing to blow the lungs. Venous pressure certainly does play a role in most cryonics cases. Perfusionists in cryonics situations aren't free to set perfusion pressures with "flow and drugs" because they may be fighting high central venous pressures and pulmonary edema at hypothermic viscosities. They also work far below the temperature at which the body can autoregulate capillary and tissue perfusion pressures.

This lack of control is one of the reasons for the classic "exsanguination hypothermic arrest" technique-- exsanguination is basically a way of saying "Okay, at this point I give up on venous pressure; I'm just going to wipe out the problem by draining more blood than I put back, until the heart stops." That's not "flow and drugs." You can get away with that at 15 C for a bit, and surgeons occasionally do so in the repair of aneurysms in medicine, where the low vascular volume also helps when flow is stopped. Cryonicists and organ preservationists don't have this option, however, since they need lower temperatures and need to continue to "flow" or circulate fluid, in order to get them. Cryonics also delivers oxygen to the brain when it can.

With the introduction of vitrification solutions below 0 C, all these problems become even more difficult.

As for pressure-regulatory drugs, most don't work well at cold temperatures. A few don't work at all. Example: one of the average perfusionist's favorite drugs, phenylephrine, does absolutely nothing at 10 C. But the average perfusionist does not know this, because the average perfusionist has never perfused anything at 10 C (swizzled martinis do not count). Let alone a living organ or body full of living organs with a closed circuit and little blood, yet vascular volumes in the normal range. (How can this be? Answer: use of artificial perfusate instead of blood).

In short, very few people actually have cryobiological experience. But most that don't, know that they don't. I'm continuously amazed at the people who don't, but think they do.

SH



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Finance Department
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What We Do Not Know (Still Looking For Answers)
July 13 2007, 12:12 PM

"Knowing what one is talking about" - I could go a lot of places with that, but for now I will state the obvious, that it ought to be obvious to most readers here by now, as to when I am speculating and when I know something for sure. I tend to speculate when I do not know something for sure. Most people do.

Those who prefer the absence of speculation on this forum, are well advised to provide information that makes such speculation unnecessary.

And here are some things those of us not in the "inner circle" still do not know:

1) The SA CASE WRITEUP, now well past a small number of weeks (2) after I was told that was how long it would take, by one who would appear to be a member of that cognoscenti. Well, granted, 3 weeks would still be small, though less small, 4? stretching the definition a lot.

2) A statement from SA regarding how they intend in the future to provide standby and transport services per the specifications in their contract, particularly in regard to the personnel resources stipulated there.

There may be other items that could be added to this list, regarding the equipment and procedures employed on the SA case, the transportation issues, maybe funding issues, and maybe etc... so far we who are not "in the know" do not know how to ask many of those questions, if they are there, and it is a bigger strain to speculate about some of them than I care to indulge in, for now.

There's the power of knowledge and the value of concealment - those blissfully unaware remain in bliss. Just the "thought for the day", nothing else


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Melody Maxim
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Distraction
July 16 2007, 8:55 AM

HARRIS: "Gravity has been used to set pressures in many cryobiological organ preservations, which resemble cryonics far more than does mildly hypothermic perfusion."

It would take a real stretch of the imagination for someone who is familiar with these procedures to believe that the perfusion techniques used in cryonics washout and/or cryoprotectant perfusion (vitrification), are more similar to techniques used in organ preservations, than the techniques used in open-heart surgery. It's absurd for Harris to offer up these comparisons. The perfusion circuit and techniques used in the cryonics washout procedure are fundamentally the same as what is used in open-heart surgery.

HARRIS: "Actually, a certain amount of venous suction by gravity drainage (or else active suction by different mechanisms) does play a role is many, perhaps most, modern perfusion cases."

Of course patient pressures depend on good venous drainage, which is why venous reservoirs are placed as close to the floor as possible. These reservoirs are NOT moved up and down during the case, in order to control patient pressure by means of gravity! Everyone here is capable of understanding that, if you pump fluid into a container, (in this case, a patient), without proper drainage, the pressure will increase. This doesn't mean that gravity is "used to control patient pressures." That's really a weird sort of distortion of the truth.

HARRIS: "This lack of control is one of the reasons for the classic "exsanguination hypothermic arrest" technique-- exsanguination is basically a way of saying 'Okay, at this point I give up on venous pressure; I'm just going to wipe out the problem by draining more blood than I put back, until the heart stops.'"

This is a gross misrepresentation of the rationale for this technique, and I can only assume Harris is using it for distraction of the people who are not familiar with these procedures. He's been taking our discussions off on every tangent he can think of. "If you can't dazzle them with brilliance..."

I believe the gravity method Harris and SA are referring to is the simple hanging of the perfusate higher than the patient and letting the fluid drain through the patient, and I fail to understand why we are even discussing this method. From the SA web site:

"The reservoir also can be supplied with preservation solution by a gravity feed, which simplifies the perfusion circuit."

Yes, it simplifies perfusion the way using a horse and wagon, instead of a car, simplifies transportation. It's their backup for the RUPs who don't know how to use the perfusion equipment.


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Melody Maxim
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My Error - Apology
July 16 2007, 12:05 PM

From the SA website: "The reservoir also can be supplied with preservation solution by a gravity feed, which simplifies the perfusion circuit."

My comment: Yes, it simplifies perfusion the way using a horse and wagon, instead of a car, simplifies transportation. It's their backup for the RUPs who don't know how to use the perfusion equipment.

This was a mistake, on my part. I initially misread this to mean that the washout can be done by gravity, something I've seen stated in other SA documents. Yes, the reservoir is fed by gravity. In fact, that was one of my own changes to the circuit!! This does not affect the patient's pressure.

I apologize for my mistake and any confusion I have caused. I'll have more tea before my next morning post!


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Finance Department
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Now there are some clues!
July 10 2007, 10:32 AM

"... and now me (harder still)..."

"...I already know a clinical perfusionist with a better appreciation for where his knowledge ends and other's begins...

Ahem, yes. I'm looking forward to the announcement of who that person might be, and also who will be the general manager (said by Platt to be announced before long). Long live SA!!



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Melody Maxim
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Clues and the CCR Perfusionist
July 11 2007, 10:03 AM

I wouldn't take these clues too seriously. At first, I thought filterpatrol was Charles, then the possibility that it was Saul crossed my mind, (but only very briefly), now I'm wondering if it's Harris talking to himself, or if it is someone else at CCR. I think the last option is the most likely. I think whoever it is should put their reputation on the line and identify themself, after the comments that have been made. Some clues:

From filterpatrol's last post:
"because I already know a clinical perfusionist with a better appreciation for where his knowledge ends and other's begins"

From Harris' July 2 "The Sky is Falling" post:
"who as it happens has pumped more than 3,000 cases in his 17 year career, and shakes his head in amazement at what happens here experimentally. The difference between him and Melody Maxim, is that our perfusion advisor can recognize where he's hit the wall, in terms of his own prior relevant perfusion experience."

I'll assume filterpatrol and Harris are referring to the CCR perfusionist. I don't know this person very well, but I have spoken to him on the phone, once, (in a conference call that included Harris and Russell), and I have a number of emails from him. Essentially, he's validated every comment and suggestion I've ever made in regard to SA's perfusion circuit. The last I heard, this person was employed fulltime as a clinical perfusionist in heart surgery. I have an email from someone at CCR, stating that they schedule their experiments requiring perfusion around his heart surgery schedule.

Seeing as how CCR's cases are experimental research, it wouldn't be appropriate for their perfusionist to question the perfusion parameters, as those factors are a part of the experiment. I would shake my head in amazement, too, at seeing CCR's dogs walk around and eat, after the experiments they were subjected to, but I would still feel as I have already stated in my response to Harris' "The Sky is Falling" post. The dogs walking around and eating after a a short-term experiment is one thing, but waking up after a hundred years with your personality and memory intact is quite another. I'm not saying CCR's experiments lack value, I'm just saying we have to hold them in perspective.

Perhaps CCR's perfusionist isn't shaking his head in amazement, at all. If he's not, I invite him to view filterpatrol's remark that gravity is the "only way to reliably maintain a set perfusion pressure without automated feedback control." If this perfusionist, (I know his full name, as well as his nickname, but I won't use them here until someone else does), agrees with that statement, I invite him to publicly express that agreement on this forum and sign his full name. If that happens, I'll post links on every perfusion forum in this country, and we'll see what his peers think of that remark.

There are a lot of cryonics issues I have not discussed here, and that is because I DO know my limitations. However, if they want to discuss clinical perfusion, or basic engineering and design principles with me, I can hold my own. I would guess it is very likely that the CCR perfusionist *knows his place,* as well as he knows his limitations.


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Melody Maxim
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Afterthoughts...
July 11 2007, 2:07 PM

Why is it that, after five years, SA sends a fabricator, who has absolutely no prior medical experience, to perform perfusion on their human patients, while CCR uses a certified perfusionist for their dogs? If Harris and Platt, et al, know so much about performing perfusion, why is CCR paying for a bona fide perfusionist, and arranging their schedule around his free time from heart surgery? Why doesn't LEF just send one of Platt's RUPs for Harris' experiments? Hmmmm...maybe the real perfusionist is less expensive than a RUP.

How is this superior to Alcor's services? Didn't SA promise "the best" in standby, stabilization and transport?

Just thinking outloud.


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Finance Department
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It's the Contract Which Is My Greatest Concern
July 11 2007, 8:43 PM

SA's contract provides for a "surgeon" capable of doing perfusion. While it doesn't say that person has to be specialized in perfusion, it would be great to have such a person available for standby at a moment's notice. Since Kent owns both companies, maybe he could buy the fulltime services of that one who works parttime at CCR, to be available to hop on a plane 24/7, and do CCR's research the remaining 40 hours of the week? Just an idea. I'm sure "filterpatrol" would appreciate having such a person handy when he needs it, rather than that person saying "no" due to being busy at the hospital.

But, fully recognizing the contract does not necessarily call for an individual of that degree of expertise (I'm sure a lot of lesser paid individuals with some kind of medical background could be, and many times have been, trained to do cryonics perfusion), my question is: which of the 3 individuals who flew to Wisconsin were so trained? Also, which of them is a "Paramedic, Emergency Medical Technician, or similarly qualified individual"? And, had the team leader "participated in at least three prior standbys"? Finally, were there "two additional team members who have been trained in SA-CI Standby fundamentals" present, that Charles Platt did not mention to me when I asked who was on the standby team?

Still lacking the SA CASE WRITEUP, which might shed some light on those questions, I fear that the answers will fall far far short of being even anywhere close to the idea of "best efforts".

The contract terms for the team member qualifications actually appear quite good, to me. It doesn't look like really expensive people are needed to meet them. I hope to see an explanation soon of what SA intends to do about this problem. *Does CI have similar concerns about this??*

Here, again, is the pertinent excerpt from the SA/CI contract:

http://www.cryonics.org/SA/SA_Protocol.html

"When SA manages an SA-CI Standby it shall make best efforts to deploy team members as follows:

Team Leader, being an individual who has participated in at least three prior standbys.

Paramedic, Emergency Medical Technician, or similarly qualified individual able to intubate, establish an intravenous line, mix and push medications, and perform similar tasks.

Surgeon, with the capability to raise femoral (or other suitable) vessels, cannulate, and perfuse with blood washout
solution. Either the Team Leader or the Surgeon must be able to push meds, place the Thumper, assess vital signs, and perform other medically-related tasks.

At least two additional team members who have been trained in SA-CI Standby fundamentals.

No fewer than two team members shall be awake and as near the SA-CI Standby Recipient as possible during each 12-hour period of the SA-CI Standby, while the remaining team members rest in accommodations nearby."


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Melody Maxim
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It's the Patients That Are My Greatest Concern
July 11 2007, 10:57 PM

FD: "Since Kent owns both companies, maybe he could buy the fulltime services of that one who works parttime at CCR, to be available to hop on a plane 24/7, and do CCR's research the remaining 40 hours of the week?"

That's unlikely to happen. Most perfusionists would not be willing to give up their certification to work fulltime in cryonics. Perfusionists with as much experience as the one at CCR frequently earn into six figures, so it's not something they are willing to risk. There's an annual minimum number of NOT legally dead patients required to maintain ABCP certification. I lost my certification, after I quit my position to remarry and move to Florida. I was ready for a break, being a single mother who had carried much more than double a normal caseload for several years. I've learned a lot of other valuable skills, working with my husband in the toy design business, and I've been free to spend a lot more time with my children than I was as a perfusionist.

I haven't checked on recertification requirements, lately, but I believe I would have to find a group willing to let an uncertified perfusionist pump 100 cases, before being eligible to sit for the board exams, again. This would not be impossible, but extremely difficult, especially for someone who cares about where they live. There are not perfusion jobs on every street corner. At any one time, there are probably less than 50 open perfusion positions in the country. There's usually less than half that number being advertised, as it's easy for most groups to find someone by word of mouth. I've had a couple of people contact me with job offers, but they were in extremely cold climates, far away from my extended family. I'm not really looking for a job, anyway. Regardless, I would have loved to have been able to stay at SA, if the circumstances had been different. I find cryonics a fascinating challenge. Besides, who wouldn't want a well-paying job, six miles from their home, with flexible hours and generous vacation time?!


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Finance Department
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It's the Contract that's supposed to define what the patients get.
July 12 2007, 12:48 AM

The contract stipulates certain levels of service that are to have been given their best efforts to effect. These levels are probably nowhere near the quality that Melody thinks is important. I'd prefer we had been debating those levels and issues after the contract levels had been provided. Unfortunately, it appears that even the contract levels provided in the recent case, get about a "D" on a scale of A through F.

So am I concerned about the patients? You bet I am. And I ask again, is CI concerned - are they addressing these apparent contract violations with SA? If not, why not?

And thanks to Melody for the insight on a certified perfusionist maintaining that status, and they could not do so working fulltime for cryonics.

So we are left with the loose end of how SA intends to provide at least their contractual level of service, in the future, to CI, ACS and any other patients.

Then there is the other loose end: Saul Kent. We can only speculate about this, as it is unlikely he will come out of the closet and speak freely with us here. So I will speculate. It is already rumored that he promises a huge 7 figure payoff to whomever in the future effectively reanimates "the real Saul Kent". How that could be determined and why there would even be any question, is something totally metaphysical to me. But so what. I bet he has also promised similar rewards to any and all of the "inner circle" who immediately speeds to his aid when the need for cryopreservation service is imminent. That circle could also now include said perfusionist, for whom a 7-figure incentive could easily cause a sudden fit of malaise requiring immediate departure from the hospital, upon receiving a certain page or call. That scenario also could possibly explain filterpatrol's remark "I already know a clinical perfusionist with a better appreciation for where his knowledge ends and other's begins" which was given in the context of discussing who might provide perfusion services. And the next day, of course, said perfusionist could go right back to work at the hospital, his sick day over and all his live human perfusion credits still in place, having pocketed a big one.

Makes me almost think the only way I will find a decent cryonics organization to join, and standby/transport service to employ, is to do my own and pay them big bucks, like Mr. Kent apparently does. I could almost do that, and probably will be able to do it before too many more years, but I have to wonder if the chance of cryonics is even worth that much bother. I'd rather join organizations and hire the services of companies that are honest and competent. Yes I'm the ultimate customer, not the true believer activist. So sell me with real stuff. No Alcorspeak or ignored contracts, please.

FD


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Melody Maxim
(Login melmax)
Veteran Member
Re: It's the Contract that's supposed to define what the patients get.
July 12 2007, 9:54 AM

FD's message title makes a good point. I think his grade of "D" for the SA services also makes a good point. In consideration of the amount of time and money that's been afforded them, they should be doing much better than they are.

FD: "And I ask again, is CI concerned - are they addressing these apparent contract violations with SA? If not, why not?"

I also wonder a lot about this. It bothers me that the CI home page refers to the SA personnel as "cryonics professionals." http://www.cryonics.org/

FD: "It is already rumored that he promises a huge 7 figure payoff to whomever in the future effectively reanimates "the real Saul Kent"."

Well, he won't have to worry about making that payout, with the "team" he is building for himself. I wonder if he realizes that, in just a few more years, LEF will have already spent seven figures on SA? And for what? I don't think they're getting their money's worth.

FD: "That circle could also now include said perfusionist, for whom a 7-figure incentive could easily cause a sudden fit of malaise requiring immediate departure from the hospital, upon receiving a certain page or call...And the next day, of course, said perfusionist could go right back to work at the hospital, his sick day over and all his live human perfusion credits still in place, having pocketed a big one."

Most heart teams have just enough perfusionists to carry their caseload. Often, per diem perfusionists must be brought in to cover for vacation time. Unless a perfusionist works with a very large group, they don't get "sick" days. My group was doing 600 cases a year, with only two perfusionists, when I resigned. That's rather an extreme number, so let's just say you have two surgeons and two perfusionists doing 200 cases a year. If one perfusionist is ill, of course their partner will show up to do a scheduled case for them, but what happens if a scheduled case is in progress and an emergency case shows up for the second surgeon? The second perfusionist had better show up, sick or not, or else he/she had better already be a patient in the hospital! I can't tell you how many cases my partner and I did, when we were ill. I did cases right up to the day I gave birth to each of my sons. Luckily, one of our physician assistants was a certified perfusionist, so he was able to cover for me for a few weeks after my children were born. Even this put a strain on our group, as they really needed him to function as a PA, and assist at the table.

FD: "Makes me almost think the only way I will find a decent cryonics organization to join, and standby/transport service to employ, is to do my own and pay them big bucks, like Mr. Kent apparently does."

You wouldn't need to spend that much money. Maybe half that for a couple of years, and even less, after all the equipment has been purchased and modified, or built.

FD: I could almost do that, and probably will be able to do it before too many more years...",

Let me know when you are ready.

FD: "...but I have to wonder if the chance of cryonics is even worth that much bother."

We all have to wonder that, and it could be a long time before we know the answer. Has any group attempted to vitrify an animal, and then wake it up after a year, or two? (I'm asking, I really don't know.)

FD: "I'd rather join organizations and hire the services of companies that are honest and competent."

I know you are critical about Alcor, but they are, without a doubt, the most capable organization at this time.


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Steve Harris
(Login StevenHarris)
Veteran Member
Re: Afterthoughts...
July 13 2007, 3:04 AM

Maxim: Why is it that, after five years, SA sends a fabricator, who has absolutely no prior medical experience, to perform perfusion on their human patients, while CCR uses a certified perfusionist for their dogs? If Harris and Platt, et al, know so much about performing perfusion, why is CCR paying for a bona fide perfusionist, and arranging their schedule around his free time from heart surgery? Why doesn't LEF just send one of Platt's RUPs for Harris' experiments? Hmmmm...maybe the real perfusionist is less expensive than a RUP.

How is this superior to Alcor's services? Didn't SA promise "the best" in standby, stabilization and transport?

Just thinking outloud.

===================

COMMENT:

And since you answered your own question reasonably well in your speculations in your next few messages, perhaps you should have done more thinking before posting.

But yes, for the record, dog experiments can be scheduled around a working perfusionist's clinical work (which needs to continue, lest they lose their edge). Whereas, cryonics cases can't be scheduled at all. That's the basic problem of all cryonics standby for all professions, and after all this time and all everyone has tried to tell you, you're only now (between this and your next couple of messages, apparently) getting a glimmer of this, and only as it applies to you, and your profession!

When you finally manage to generalize your epiphany, you'll be on the way to a basic understanding.

SH



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Steve Harris
(Login StevenHarris)
Veteran Member
Answers assumed
July 13 2007, 3:21 AM

Maxim: "I would shake my head in amazement, too, at seeing CCR's dogs walk around and eat, after the experiments they were subjected to, but I would still feel as I have already stated in my response to Harris' "The Sky is Falling" post. The dogs walking around and eating after a a short-term experiment is one thing, but waking up after a hundred years with your personality and memory intact is quite another. I'm not saying CCR's experiments lack value, I'm just saying we have to hold them in perspective."

COMMENT: For the record, the dogs are required to learn many new behaviors and be fully socialized. After that, there's no point in doing more to them. Many get adopted out.

Your comment previously was "The only way to possibly detect subtle neurological damage in Harris’ experiments would be to autopsy the dogs and examine their brains."

I just took this for your general inexperience in resuscitation research, but since you keep repeating the same sentiments, I might as well tell you that there isn't any gold standard in resuscitation studies of higher animals to assess neurological damage. Behavioral scoring correlates well with, and is as sensitive as, brain histopathology (see Utstein guidelines, which does not prefer one to the other) and that is why there are many studies in resuscitation which do not bother to check for anything more than neurobehavior scoring. (See for just one modern example http://circ.ahajournals.org/cgi/content/full/105/1/124)

Not that it proves anything about animals, but behavior is more sensitive than gross brain examination in humans, of course. Nobody has yet identified "pumphead" on autopsy, even though autopsies are done all the time on people who have had symptoms of it. That said, good human histopathology after resuscitation is rarely done. So the question is still whether or not animals will mirror humans in this, and the answer is still not in. However, it's not obviously different for animals vs. humans, as you seem to think. One more place where you assume you know the answer, even though there isn't a glimmer of it.

SH




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