During the month of November the research and development team made a field trip to a local medical CT scanning service, taking with them two recent neuro patients. Due to circumstances surrounding their death, one patient was cryoprotected and the other was not.
Patient safety is Alcor’s main objective, and with that in mind our neuro patients were transported inside individual liquid nitrogen dewars securely tied down and well padded against vibration in the back of our Rescue Vehicle.
Having safely returned from our trip and taking care of returning the patients to the patient care bay, Steve Graber opened up the first of the patient scan files in our 3-D visualization software. This is where the team could really see some interesting things. First, using the ‘Slice’ tool to remove a small section of the skull (Fig. 1) and looking into the brain cavity we could make out the sensor wires which were previously placed into the brain cavity during surgery. Through the slice we can see variations in brain density which is visible in the red and purple range. NOTE: Color designations are entirely arbitrary.
A direct comparison of two brains digitally enhanced in software (Fig. 2) highlights unusual density variations between brains. When one compares these identically composed, sectioned and displayed images of a cryoprotected brain (top image) vs non-cryoprotected brain it is clear that there is a big difference in overall density between these two brains. A-1546 displays a significantly greater electron density than A-1088 throughout the majority of the brain. Overall the A-1546 brain is much more electron dense and we believe this to be evidence that perfusion did occur, at least in certain areas. It is important to note that we do not feel that complete perfusion of cryoprotectant was achieved across the entire brain. This may be due to the fact patient A-1546 was pronounced out of state and experienced a travel time of 18 hours from pronouncement to the beginning of the cryoprotective ramp in the Alcor O.R.
A future test of a variety of substances under the CT scanner in LN2 is expected to help to identify electron density specifics of cryoprotectants, which in turn will make our analysis that much more complete. We also expect to test a locally pronounced patient vs an out of state pronounced patient to determine the quality differences in cryoprotection caused by the time-lag to cryoprotection between these two scenarios.
Alcor member A-1277 was pronounced on Friday, December 9, 2011. A whole body case, A-1277 became Alcor’s 110th patient.
A member in the Yonkers, New York area had been in and out of the ICU at a local hospital for more than two months. Her son, also a member, was the liaison between Alcor and her medical providers. Despite numerous procedures and an encouraging recovery, she suddenly and somewhat unexpectedly succumbed to her illness, arresting at 3:55 AM (MST) and then pronounced. Previous communications with the hospital and a local mortuary prompted immediate heparinization, circulation, ice application and an expedited release from the hospital.
The time needed for a team response was greater than simply initiating an immediate airline shipment. Therefore the patient’s cooling was continued by the mortuary along with packaging and processing of the appropriate paperwork. The patient arrived in Alcor’s surgery suite at 10:13 PM on Friday night at a temperature of 2.6C. Cryoprotection was ended at 3:02 AM on Saturday December 10, and cooling with liquid nitrogen begun at 3:50 AM. At the time of writing, A-1277 is at -140C and cooling.
In November, Steve Graber reported on a table cooldown test to -80C using saline water which demonstrated that the water bags in the cooldown chamber experienced difficulty passing through the ice temperature barrier, resulting in a very long cooldown process. Ultimately the test was stopped before the bags reached any appreciable cooling. Additionally, the research and development team noticed the table was cooling the leg portion much quicker than the remainder of the table.
The test was designed to more closely approximate the cooling characteristics of an actual patient scenario by using a mixture of anti-freeze and water in a 70/30 mix, rated to -65C. Steve’s test was run in essentially the same fashion as the previous run with identical LN2 consumption (two 200-liter dewars), and the data collection continued for an additional day to record the warmup segment. The table cooling tuning has been slightly over-corrected with the head and torso areas now cooling more quickly than the leg area. This should now allow him to dial in corrected vent opening settings for even cooling across the table. In the test the team noticed a significant improvement in the temperature drop vs saline water. At the end of our 10 hour test both the head and torso bags are nearing terminal temperature and the leg bag lagging behind. We achieved close to -80C cooling on our test bladders using LN2 at about the same rate as our current cooldown equipment.
Alcor had 958 members on its Emergency Responsibility List. Seven memberships were approved during the month of November, one membership was reinstated, no memberships were cancelled and one member was cryopreserved. Overall, there was a net gain of seven members in November.
Alcor had 44 applicants for membership. Seven new applicants were added, seven applicants were converted to members and eight applicants were cancelled resulting in net a loss of eight applicants in November.
Information Packet Statistics
Alcor received 92 info pack requests in November. Twelve were handed out during facility tours or from special request. The average total of 105 info packs sent per month in 2011 compares to 199 in 2010. The full Information Packet is now available online.
The next Alcor Board of Directors meeting is scheduled for FRIDAY , January 6, 2012, at 11:00 AM (MST) at the Alcor facility (7895 East Acoma Drive in Scottsdale, AZ). Members and the public are encouraged to attend.