Premedication in Cryonics Revisited
Disclaimer: Alcor cannot provide medical care for living patients and must regard the care and medication of legally living members as the sole responsibility of members and their treating physicians. To avoid conflict of interest Alcor cannot advocate premedication protocols for cryonics patients.
If there are medications, nutrients, minerals, and/ or vitamins that can mitigate the adverse effects of ischemia after circulatory arrest, it stands to reason that some of these strategies may even confer greater benefits if they are already being pursued prior to pronouncement of legal death.
Two surveys of the topic of premedication, the only such writings that I know of, were penned by Michael Darwin many years ago. The first is “Reducing Ischemic Damage in Cryonic Suspension Patients by Premedication” (Cryonics, April 1991). The second, more extensive treatment is “Premedication of the Human Cryopreservation Patient,” Chapter 7 of the 1994 cryonics manual Standby: End-Stage Care of the Human Cryopreservation Patient. One case report showing use of premedication is that of James Gallagher, 1995 (Alcor Patient A-1871).
In his contributions, Darwin covers topics such as medico-legal issues, risks and benefits, patient evaluation, drug categories, specific medications, evidence, contraindications, etc. Here I briefly review some recent stabilization medications research for its relevance to premedication protocols.
Broadly speaking, there are two categories of premedication drugs: (1) Drugs aimed at preventing certain events following circulatory arrest and (2) drugs aimed at mitigating the damage that (inevitably) follows circulatory arrest. An example of the former is prevention of blood clots and an example of the latter is ischemia-induced free radical generation.
When our lab, Advanced Neural Biosciences, conducted stabilization medications research we administered medications prior to or concurrent with circulatory arrest. This model is effective in
looking at the efficacy of drugs but in real human cryopreservation administration of medications is often delayed. An interesting feature of this model, however, is that it may tell us something about the efficacy of these medications had they been part of a premedication regime.
As reported in our research summary in the January-February, 2017 issue of Cryonics magazine, we only found consistent and beneficial effects for two medications; heparin and sodium citrate. Both agents prevent the formation of blood clots, although sodium citrate may also exhibit general neuroprotective properties as a calcium chelator.
If we reflect on these results with the two categories of drugs discussed above in mind, it is tempting to conclude that only drugs that can prevent a specific ischemia-induced effect (like blood clotting) can improve the cryopreservation of the patient. This would be premature to conclude at this stage. Not just because of our choice of animal model and sample size, but because some of the medications in Alcor’s stabilization protocol may better help to sustain biological viability after the start of cryonics procedures and/or inhibit biochemical events that degrade brain ultrastructure.
Stabilization medications research can provide data to formulate an evidence-based premedication program, but there are issues that are unique to premedication. For example, a highly effective agent like sodium citrate cannot be administered prior pronouncement of legal death because it immediately stops the heart. There are also medications that may be effective for the critically ill patient (for example, drugs aimed at preventing arrhythmias and sudden death during decline) that have no meaningful role to play in cryonics stabilization procedures.
Originally published as a column in Cryonics magazine, May-June, 2017