Case Summary A-2435 (Member A-2435 is now our 88th patient

Phoenix, AZ–August 9, 2009
Alcor was contacted by a member who informed us that his wife, also an Alcor member, had become gravely ill and they were traveling to Mexico for specialized treatments, in an attempt to extend her life. In the event that their efforts became futile, they intended to return to the United States and fly directly to Scottsdale to be near Alcor for the remaining days of her life.

Alcor’s deployment committee kept in close contact with the family along with her medical providers in the U.S. and abroad. Her physicians were aware of her cryopreservation directives and eventually determined that her time would be better spent getting closer to Alcor rather than continuing treatment and risk potential delays while crossing the U.S. border, after clinical death.

The family arrived in Scottsdale by Air Ambulance while Alcor facilitated her direct admittance into a cryonic’s friendly hospice provider in the Phoenix valley.

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Case Summary A-2420 (Member A-2420 is now our 87th patient

St. Louis, MO–July 25, 2009
Alcor received notice from an extended care facility that one of our members was experiencing a significant decline in health and therefore the family was in the process of changing the patient to hospice care. Alcor’s deployment committee was actively involved in monitoring the situation when it was decided to have an Alcor representative at the patient’s bedside to better determine when to initiate a full team response. Aaron Drake traveled to St. Louis to interact with the patient, family and medical staff.

Throughout the course of the seven days on location, we continually ramped up the level of readiness as the patient’s condition worsened. Initially, the full team supply kit was shipped and pre-positioned. Then, two Suspended Animation, Inc. (SA) team members drove the SA response vehicle from Florida to St. Louis. And finally, we requested a deployment from Catherine Baldwin for the full SA team including perfusionist and surgeon to provide support as clinical death was imminent. The timing was excellent as the patient experienced clinical death within 12 hours of the SA team’s arrival.

The patient was subsequently flown to Scottsdale where a neuropreservation was performed. Member A-2420 is now our 87th patient.

Case Summary A-2061 (Member A-2061 is now our 86th Patient

Colorado Springs, CO–June 7, 2009
One of our members, A-2061 suffered cardiac arrest at his home in Colorado Springs, CO. The gentleman had suffered from Parkinson’s disease for many years and had 24-hour home health care. At the request of the member and the cooperation of the home health care program, Alcor had pre-positioned a mini-medical support kit with instructions for medical professionals, to administer after pronouncement. In the event of a sudden and unexpected clinical death, these important initial medications could be administered, while simultaneously cooling the body with ice. This would accomplish a key first step in the stabilization process that would provide Alcor additional time to respond to the scene while maintaining the hope for a quality cryopreservation. Since this was the exact scenario that played out, our early efforts paid off.

The home health providers witnessed the member’s arrest and acted quickly. Local paramedics were unable to resuscitate the patient and terminated efforts on scene. The Sheriff’s office was able to assist in expediting the process of pronouncement which allowed the medical assistants and family members to begin Alcor’s initial stabilization protocols. Aaron Drake took an immediate flight to Colorado with the remainder of the needed stabilization equipment. Upon arrival, he met with the funeral home where the patient was being kept in a 34 degree Fahrenheit environment. After completing the remainder of the stabilization in the middle of the night, the patient was packaged and prepped for airline shipment back to Phoenix, which occurred later that same day.

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Case Summary: A-1407

On September 8, 2008, Alcor member A-1407 suffered cardiac arrest while snorkeling in Barbados and was subsequently pronounced legally dead. He was traveling with a companion who knew to contact Alcor immediately. Because of the circumstances and the local legal requirements, an autopsy was unavoidable. After some negotiation, the coroner limited the investigation to the minimum necessary to determine the cause of death (heart attack), and he did not touch the brain.

Alcor received good cooperation from a funeral director, who had once attended a seminar on cryonics. The decision was made to cool the patient to dry ice temperature in Barbados because cryoprotection would not be possible at Alcor due to the long time period of clinical death, and starting deep cooling sooner would stop further damage that time at warmer temperatures would otherwise cause. The paperwork required to transport the patient was extensive, and necessitated the police conclude their investigation. Alcor involved the local US embassy to expedite the process, and the Deputy Consul in particular was quite helpful.

The patient was air shipped via Miami, where he was removed from the plane in order to replenish the supply of dry ice. Flight schedules being what they were, the patient then spent the next night in Atlanta before finally reaching Phoenix. All told, it took nearly five days to receive the patient.

Unfortunately little dry ice remained upon arrival at Alcor, and the patient’s temperature was near 0 degrees Celsius rather than the -79 degree temperature of dry ice. The patient was cooled back down toward liquid nitrogen temperature for long-term storage. A-1407 became Alcor’s 84th patient.

This case led to extensive discussion and review within Alcor of procedures for shipping patients on dry ice, especially overseas, with a view toward preventing the problems of this case from recurring in the future.

Recent Cryopreservation

One of our members, A-1212, suffered cardiac arrest in Hawaii last week. The gentleman had suffered a fall and been released from the hospital, and then he fell a second time. On this admission to the hospital, he was diagnosed with pneumonia. Treatment with antibiotics was going well, but his heart stopped suddenly. We were not notified until between 15 and 30 minutes after pronouncement. Negotiations with the hospital for the application of our emergency protocol did not go quickly or smoothly. Ultimately, they did agree to begin surface cooling and administered an intranasal dose of heparin (They had removed all IV lines before we were called and were unwilling to place a new one.) before releasing him to the funeral home.

Initial negotiations with funeral homes in Hawaii were also difficult, as none were willing to commit to rapid transit. We went through three separate facilities to find one that would carry out our instructions. With all the delays, it was a full 42 hours after pronouncement that the patient arrived at Alcor, which proved faster than the original 3-4 day estimates.

The decision was made to attempt cryoprotection. We know from previous cases that vitrification is achievable after 30 hours and application of the medication protocol and surface cooling, and we decided to see if it was possible to improve our understanding of the limits to vitrification. It was quickly established that 42 hours with little surface cooling and virtually no meds, vitrification was not possible. We then straight-froze the brain.

During this case, there was much discussion of whether or not to remove the brain, chemically fix it and do a diffusion cryoprotection. Because insufficient data exists to tell us whether this would have resulted in superior structural preservation, we chose to use our standard protocol.

This patient received our 5th cryopreservation of the year, and he is our 83rd patient.

Two Recent Cryopreservations

In the past ten weeks, we’ve deployed six standby operations and have performed three stabilizations and cryopreservations (including A-2340 discussed in a previous entry).

Of the two most recent cases one patient required two standbys and the other three in advance of cardiac arrest. They were performed on opposite coasts, with the first patient coming from California and the second from Florida. Both patients were successfully stabilized, transported, cryoprotected and cooled.

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Alcor Cryopreserves 80th Patient

Over the weekend, Alcor completed an unusual non-confidential, last-minute case: the cryopreservation of Rose Selkovitch, A-2340. Rose was nearly 102 years old at the time of her cryopreservation.

Because of the last-minute nature of this case, Rose passed away as the standby team was still en route to her Escondido, California location on 29 March 2008. The transport vehicle had been deployed from Arizona with two team members and a member of the southern California team drove down. Due to advance negotiations, a dose of heparin was administered by hospice personnel after her pronouncement at approximately 20:30, chest compressions performed to circulate, and she was packed in ice upon pronouncement of legal death. By the time, the standby team and the funeral director were on-site, the cannulations completed and the washout ready to begin, Rose’s temperature was at 6 degrees C. An equipment problem and concerns about pumping the warmer blood from her chest cavity into her brain (which would warm it up significantly) contributed to a decision to not do a washout in California, but instead begin transport to Arizona for cryoprotection.

Transit paperwork was received in a timely fashion, and the transport concluded without incident. The surgery revealed that Rose had extremely large carotid arteries, and our surgeon suspected there was an aneurysm deeper in the carotid on the right side. Nevertheless, the blood washout went extremely well, resulting in a hematocrit reading that was undetectable. Cryoprotection began at 19:34 on 30 March and concluded at 00:33. Target concentrations of cryoprotectant were achieved in the brain, and first-stage cooling was begun shortly thereafter.

Support from hospice personnel and the local funeral home were instrumental in this case going well. Being just five weeks shy of her 102nd birthday makes Rose the oldest cryopreserved patient at Alcor today. She is our 80th patient.

M22 Implementation

Alcor has implemented a new whole-body cryopreservation procedure which uses a new cryoprotectant solution, M22, licensed from 21st Century Medicine. The new cryoprotectant is perfused throughout the entire body using the same procedures required for glycerol cryoprotection; but while it cryoprotects the torso, arms, and legs, we are confident that it is also vitrifying the brain. The main difference, beyond the composition of the solution, is that neurovitrification can be done without separating the brain from the rest of the body.

This new whole-body procedure will now be standard for all members currently signed up as whole body, as well as for those whole body members who have executed an open option contract.

The important thing to realize about this process is what it cannot do. This is not whole-body vitrification, in the sense that the entire body is vitrified. Significant portions of the body do not cryoprotect sufficiently to vitrify, mostly because things like fatty tissue and skeletal muscle are not well-vascularized. This new procedure may not be as optimum for brain cryoprotection as a simple neuro procedure would be, because of the somewhat longer cryoprotection and cooling times. Conversely, compromises needed to protect the brain may lead to under-cryoprotecting the body, in less ideal cases. But the good thing to remember is that brain vitrification is now available to those who wish to remain strictly whole-body, and that the entire body is cryoprotected intact.

A significant amount of engineering work was done here at Alcor to ensure the proper use of M22. A new circulating chiller and perfusion circuit were needed, as were controlled-temperature enclosures for both the patient and the perfusion circuit to allow safe perfusion at temperatures well below the freezing point of water. The patient enclosure allows further cooling after cryoprotection, to at least -30 or -40 Celsius, reducing the hazards of temperature fluctuations while moving the patient into the next stage of cooling. The credit for this engineering work belongs to Hugh Hixon and Tanya Jones, who have done a wonderful job implementing the new procedure.

Those interested in neurovitrification and whole body cryoprotection will no longer have to face the sorts of compromises they did in the past, and we believe this is a significant advance in our capabilities. For those who would like to know more about M22, the composition and effects have been published in the scientific literature listed below [reference 1]. Electron micrographs of the ultrastructure of brain tissue vitrified with M22 have also been published [reference 2] and are available on the Alcor website at http://alcor.org/library/alcor-new-york-academy-of-sciences-paper/.

Further information and micrographs explaining the switch to M22 technology for all Alcor cases can be found on our website at http://www.alcor.org/library/new-cryopreservation-technology/.

As explained in reference 1, M22 has been shown to be compatible with high viability of tissue slices and with consistent survival of kidneys after transplantation. This allows the unprecedented vitrification of the human brain within the intact human body using a solution that is in principle capable of preserving tissue viability as measured by present-day methods. However, to be sure that the brain will vitrify in compromised human patients, Alcor currently must perfuse M22 for longer periods of time than those shown to preserve viability in model systems. In addition, M22 has not yet been shown to preserve the viability of the brain in model system studies.

Nevertheless, the use of M22 allows Alcor to come closer than ever to achieving the goal of in situ brain vitrification using perfusion conditions that preserve tissue viability by current standards. It keeps Alcor on the road to the possible, eventual attainment of this goal. [SVS/TJ]

(1) Fahy GM, Wowk B, Wu J, Phan J, Rasch C, Chang A, Zendejas E. Cryopreservation of organs by vitrification: perspectives and recent advances. Cryobiology. (2004) Apr;48(2):157-78. http://www.21cm.com/pdfs/cryopreservation_advances.pdf

(2) Lemler J, Harris SB, Platt C, Huffman TM. The arrest of biological time as a bridge to engineered negligible senescence. Ann N Y Acad Sci. (2004) Jun;1019:559-63. Review. http://alcor.org/library/alcor-new-york-academy-of-sciences-paper/