Alcor News Bulletin
                   Number 27: June 9, 2004


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                     Authors This Issue:

Jennifer Chapman [JC], Tanya Jones [TJ], Mathew Sullivan
[MS], Mike Perry, editor [MP].


                        In This Issue:

*     Last-Minute Case in May
*     Dewar Relocation
*     More about the Taller Dewar
*     Local Standby Performed
*     Gas Cooling for Whole-Body Patients
*     On Readiness
*     Membership Statistics
*     Next Board Meeting


                   Last-Minute Case in May

Alcor was contacted by the son of the patient, an elderly
woman being sustained on life support in the Miami area.
Informed consent, legal documentation, and payment were all
obtained promptly, and a two-day standby was performed.
Because they happened to be in the area, Joe Waynick and
Todd Huffman collaborated with the Florida teams to provide
standby and stabilization care.

The patient, Alcorís 64th, was pronounced in the early
morning of May 13, the expected medications were
administered, and she was then removed to a funeral home.
Because of extensive sclerosis in the femoral vessels, the
patient was washed out using the right carotid, but this
fact was not communicated to the operating room team and
precipitated an early cryoprotective ramp. Because the neck
was obscured by ice bags and drapes, we failed to locate the
additional source of leakage in an already difficult
surgery. Despite the problems during surgery, the
cryoprotection went fairly well.

This whole-body patient was cooled to -79įC using the
upgraded cooling system that was deployed between our recent
cases (more on whole-body gaseous cooling below). She will
also be the first patient placed into the new patient care
bay. [TJ]


                      Dewar Relocation

With this latest whole-body addition to our patient
population, we had to activate our last remaining Bigfoot,
#8, which was also the last Bigfoot unit constructed. Unlike
previous units, it is too tall to simply push through the
door. (The extra height means greater efficiency in use of
liquid nitrogen, which lowers the cost of patient
maintenance--see the article that follows. For this reason
we expect our future Bigfoots to all be of this taller
design.) Unfortunately, this meant we had to move the dewar
to its new home prior to filling it with nitrogen and
transferring the patient and prior to the completion of the
patient care bay renovations. The move, completed May 26,
required that we rent a crane and extension. We were then
able to lift and tilt the dewar sufficiently to pass through
the existing patient care bay door.

Last October we had provided for the new patient care bay by
raising the height of one door to accommodate the taller
dewars we would be placing inside. Once we got Bigfoot #8
outside and in front of the taller door, rolling it into
place was simple; everything went smoothly.

Until the two new dewars currently under construction are
completed later this summer, we have only the two cooling
units as back-up. [TJ]


                 More about the Taller Dewar

Our newest dewar, Bigfoot 8, stands approximately ten inches
taller than the other Bigfoots, and the lid on top is
correspondingly thicker, with 24 inches rather than 14
inches of insulating styrofoam. The extra insulation means
the interior is better protected from outside heat, which
means that liquid nitrogen boils off more slowly. To quote
some actual figures, preliminary testing indicates Bigfoot 8
is boiling off about 12 liters of liquid nitrogen per day
versus 14-15 liters per day for the other Bigfoot
containers. It may not seem like much, but itís roughly 15-
20 percent less nitrogen consumption, and over time it will
add up. [MP]


                  Local Standby Performed

One of our local members contracted an unspecified
infection, one that led to his being admitted to the
hospital critical care ward for nearly ten days. On May 23
we launched a standby team on-site and maintained it for
nearly a week, until the patient had recovered sufficiently
to be transferred from the ICU.

This patient has recovered well and was released from the
hospital prior to the Board meeting. [TJ]


          Gaseous Cooling for Whole-Body Patients

Our procedures for the first-stage cooling of whole-body
patients have typically involved placing the patient inside
a pair of plastic sacks, lowering them into a bath of
silicone oil, and adding dry ice at regular intervals to
reduce the temperature. As a well-trusted legacy system,
using the oil bath on whole-body patients was considered a
given, despite its less-pleasing aspects.

The oil was slippery and a safety hazard during transfers.
It was difficult to clean after each patient, requiring up
to a week of filtration to restore for the next use. The oil
was also expensive, and every case led to some loss to the
system. Moreover, it was time-consuming to place a patient
into several plastic bags prior to the start of this first-
stage cooling (to dry ice temperature) and then remove the
bags afterward prior to the final cooling (to liquid
nitrogen temperature). Inevitably there was some warming of
the patient at both points in the cooling process; clearly
it was time to phase out the silicone oil used in our

A while back, James Sikes and Hugh Hixon had spent time
developing the hardware needed for gaseous cooling of whole-
body patients. Overall, it took little time to assemble the
parts needed to make the changeover. The new system, it
turns out, has a decided advantage. It allows a rapid plunge
to a temperature slightly above the known cracking points of
the cryoprotectant used (in this case, glycerol), which
serves to significantly reduce ischemic injury.

The hardware worked as planned, the computer-controlled
descent went as expected, and all parts worked together to
give this latest patient the fastest whole-body cooling to -
79įC ever. We havenít removed the silicone oil from the
facility yet, but plan to wait until there has been
sufficient reliability testing on the new system. [TJ]


                       On Readiness

After the last cryopreservation, all the pumps from the
heart/lung machine were removed for cleaning and as a
consequence the stand became top-heavy and toppled. Our
computerized LabView system with thermocouple and
refractometer equipment fell on the floor.  Both monitors
were damaged and disposed of and the other equipment has not
been fully tested to see if it is problem-free. Until this
equipment is brought back on line, we will have a greater
need for helpers in the operating room for sample taking.
Prior to the use of LabView we had 5 team members (including
sample takers for lab testing) who were dedicated to taking
samples and charting the refractive index on the wall. More
extensive testing will occur once all critical readiness
tasks have been completed.

Over a 10-week period this year Alcor performed 5
cryopreservations. Our current state of readiness has
improved over what was reported by Mathew Sullivan to the
Board last month, despite the fact of adding another
patient. Yet we are beginning to see the limitations in our
ability to deliver service as a consequence of waiting to
get our equipment sterilized. Following the last
cryopreservation we were on alert for a local member, and
had both our whole-body and neuro instrument trays in for
sterilization. Our problem is more challenging because of an
increase in the turnaround time caused by moving to a new
provider: from 1-2 days to as much as a week or more.
Without additional surgical instruments and/or our own
ability to sterilize our equipment there will be
complications in the future with our current rate of
activity. We are investigating our options on both of these
issues. [MS]


                    Membership Statistics

On May 31, 2004 Alcor had 660 members on its Emergency
Responsibility List. One membership was approved during this
month, no memberships were reinstated, two cancellations
were processed, and one suspension was performed. Overall,
there was a net loss of two members this month. [JC]


                      Next Board Meeting

The next Board meeting is scheduled for Saturday, July 10,
2004 at 11:00 AM (PST), also 11:00 AM local Arizona time.

Board meetings are held on the first Saturday of the month
at the Alcor facility (7895 East Acoma Drive in Scottsdale,
AZ). Members are encouraged to attend.

End of Alcor News bulletin #27 dated June 9, 2004.
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