Tag: Suspended Animation

Imagine there's no sleep

Imagine that human culture has never experienced sleep, but suddenly must experience it to survive. Would they be apprehensive about experiencing it for the first time?

Of course!

Just picture… this total suspension of consciousness, experienced for the very first time in human history. The notion would totally blow our minds. It would be completely shocking. We might even make up stories about dying and being replaced by an identical clone being, or trying to console ourselves that at least we will have a successor on the following day to carry out our desires.

Contrary to popular belief, there is no particular reason to assume that humans who “survive” events like freezing or vitrification would be any different from humans that “survive” sleep or anesthesia. The definition of consciousness we care about is the lifelong continuity of experiences created by memories. We might not like donating 8 hours out of every 24 to a form of comatose oblivion, but we are able to tolerate it. We would die without it — and who wants to die?

Suppose we were to meet an alien culture that undergoes 8 hour periods of liquid nitrogen immersion every night instead of sleeping. We wouldn’t find it a significant barrier to relating to them as fellow sentient beings. We wouldn’t find it socially necessary to mourn their deaths every night or become reacquainted with their newly generated “progeny” every morning. We would just think their suspension habits are an interesting facet of their biological existence, much like they might regard our sleeping habits.

Some people seem to have the idea that cryonics patients can only be “dead” by definition — that the cessation of metabolic activity somehow makes survival via cryonics an absurdity. It is true that current cryonics patients are legally and clinically dead, but that is a matter that will probably change as scientific and social progress is made. In the mean time, there needs to be a clear distinction between destruction and deanimation — which unlike “death” are not social, legal, or philosophical terms but empirical events, much like sleep.

Suspended Animation Conference 2011

The cryonics company Suspended Animation “will sponsor the conference, “Suspended Animation – The Company and The Goal,” which will be held in Fort Lauderdale in May, 2011. The conference will feature speakers on the latest strategies and advances toward perfecting reversible human suspended animation. During the conference, SA will also host tours and demonstrations at its facility in Boynton Beach.”

More information about the program, registration, and the free live webcast can be found on the Suspended Animation 2011 conference page.

From the conference brochure:

“The Whole-Body Vitrification Project – Greg Fahy, PhD — 21st Century Medicine, Inc. Major new findings from Phase I of a revolutionary longterm project to achieve reversible whole-body solid state suspended animation in humans. This project, conducted at 21st Century Medicine, is the only whole body vitrification research being conducted in mammals and was funded entirely by a $5.6 million dollar grant from the Life Extension Foundation. Cryobiologist Greg Fahy will discuss how well whole animals can be cryopreserved right now, the possibility of using a single advanced vitrification solution to cryopreserve entire animals and, eventually, humans, and a unique, newly-invented technology to produce large, cryopreserved tissue slices for scanning and transmission electron microscopy. A proposal and budget for Phase II of the Whole-Body Vitrification Project will also be presented.”

Cryonics and fear of the future

To people who have made cryonics arrangements the biggest mystery remains why more people have not made the same decision. The most obvious answer remains that cryonics has not been proven to “work” yet. People who give this answer usually mean that proof of human suspended animation would lead to an increase in the popularity of cryonics. But even if suspended animation would be technically feasible there would still be the remaining obstacles of finding a cure for whatever disease the patient died of, and, for most people, the need for rejuvenation. In the absence of such hurdles there would be no need for cryonics. Cryonics per definition involves decision making under uncertainty.

In “Why is Cryonics so Unpopular?” it is proposed that the lack of technical feasibility cannot explain the current lack of interest in cryonics. Alcor is now using the least toxic vitrification agent identified in the peer reviewed cryobiology literature but this has not translated into a spike of support for cryonics. One could object that it is still not good enough. The problem with this argument is that this does not answer why more people do not make cryonics arrangements when technologies improve. There are people who made arrangements when cryonics organizations used protocols that produced substantial ice damage. So if one believes technical feasibility determines cryonics acceptance, cryonics should grow faster when its technologies improve.

Perhaps the biggest problem with the technical feasibility argument is that it seems rather strange in a world where millions of people accept all kinds of nonsense for which there is no credible empirical evidence at all. The lack-of- technical-feasibility-argument is also hard to reconcile with the fact that cryonics attracts a disproportional number of Ph.D.’s and people with backgrounds in the natural sciences. There is a lot one can say about the demographics of cryonics, but not that cryonicists are ignorant people who can be easily misled. At the 2010 Teens and Twenties cryonics meeting in Florida most of the attendees considered themselves “skeptics.”

That the technical feasibility argument is not persuasive does not mean that progress in research and improved procedures are not important. Progress in cryonics technologies will improve the chance of resuscitation of those who have chosen to make arrangements. Such progress can also be used to seek better legal protection for cryonics patients.

There have been other explanations for the persistent lack of interest in cryonics. One explanation would have it that cryonics as a concept is credible but that the quality of procedures at the existing cryonics organizations is poor. The problem with this argument is that it is simply not consistent with the empirical evidence. People who are reluctant to make arrangements rarely mention it and there is no evidence that people who research cryonics organizations study the difference between published protocols and practice in great detail. As a matter of fact, people who dismiss cryonics have little knowledge of the protocols and procedures that cryonics organizations claim to offer. Furthermore, if this argument would be correct one would expect it to resonate with people who have made cryonics arrangements as well. Alcor collects data about people who terminate their cryonics arrangements and the data do not support this argument at all.

Last, but not least, if cryonics would be credible in concept but not in practice one would expect people to join their cryonics organization of choice and attempt to improve things. Why would one choose the certainty of death over making an effort to further increase the chance that cryonics will succeed? One objection could be that cryonics as practiced today has a zero chance of working and there is no difference between signing up and not signing up. But this argument is not credible because such a claim can only made if (a) one has direct empirical knowledge of the ultrastructure of the brain that results from current procedures and (b) one has detailed knowledge of the capabilities and limits of future cell repair technologies.  The most plausible reason why critics often categorically deny the chance of resuscitation in the future is because it releases them from moral blame if their criticism of cryonics organizations would result in existing patients being removed from liquid nitrogen storage to be burned or buried.

Would cryonics be more popular if it were bundled with another tangible good or religion? Perhaps, but this fails to explain why there are a lot of unorthodox ideas with no such bundling that are a lot more popular. Bundling cryonics with a religion will alienate everyone who has chosen a different religion. As an experimental medical procedure cryonics should not divide, but unite, people. That is not to say that cryonics does not have distinct demographics that can be studied in an effort to grow cryonics.

One reason why advocates of cryonics are not successful in identifying the cause of its limited popularity may be that they are inclined to exempt cryonics as such from its explanations. The assumption is that cryonics as such is a good idea but technical or practical problems prevent its widespread acceptance. But there is a major problem at the heart of cryonics itself. Many people have little difficulty recognizing that cryonics requires a person to choose to be resuscitated in a far and unknown future.  In a sense, this property of cryonics is more about being “reborn” than about “extending life.” Humans have evolved to want to survive but this instinct does not appear to assert itself when faced with the choice to go into biostatis in anticipation of resuscitation in a far and unknown future.

Some cryonics advocates have argued that human history is full of examples of people who lose everything they have but still prefer survival in foreign and unknown places. But in all these examples the person still persists as an aware person and can respond to his environment. What makes cryonics different from these situations is that a cryonics patient in biostatis is not aware and his fate is completely dependent on the efforts of others. If friends and family have made cryonics arrangements this can provide some degree of fear reduction (as a matter of fact, for many who have made cryonics arrangements it does provide relief), but the future will be mostly shaped by people who are not friends and family.

As a matter of fact, these kinds of fear are often expressed when people discuss cryonics or futurism. And it is often among the remaining concerns if people are presented with evidence that the technical feasibility of cryonics is not as bad as they imagined. So in a sense cryonics could benefit from being “bundled” with something.  And the most important bundle is not “technical feasibility” or “procedures performed by medical professionals” but “TRUST”.  People who make cryonics arrangements should have a feeling that their fate is in the hands of people who are strongly committed to their future. This is easier said than done because it is not reasonable to expect that cryonics organizations will have a strong influence on the shaping of the environment that the patient will be resuscitated in.

The idea that cryonics is not popular because of its intrinsic anxiety-producing properties has testable hypotheses that can be worked out. It also allows for new perspectives on promoting cryonics.

Robert Ettinger on cryonics and research

One of the most common criticisms of cryonics is to argue that cryonics can only be a legitimate endeavor when there is (peer reviewed) demonstration of whole body suspended animation. Advocates of cryonics  point out that this is an unreasonable position because it sets a standard for rational decision making (certainty) that is rarely encountered, if ever, in real life. People make decisions under conditions of uncertainty all the time. Why should cryonics be held to higher standards?

Like many other arguments against cryonics, this line of criticism is addressed by Robert Ettinger in his book Man into Superman (1972):

There is one more foible of many scientists and physicians important enough for separate attention: the notion that we should spend our money on research, not on cryonic suspension. This is nonsense on its face, and on the record.

To begin with, as repeatedly emphasized, those now dying cannot wait for more research, but must be given the benefit of whatever chance current methods offer. Most of us, if we are in our right minds, have limited interest in abstract humanity or remote posterity; we are primarily concerned with those near us, and cannot forego their probable physical benefit and certain psychological benefit. But even on their own terms, those who complain that research should come first are wrong.

Cryonics does not divert money from research, but channels money into research, and it is the only likely source of such funds in large amounts. Those who speak of using the funds for research “instead” of cryonics are out of touch with reality: these are not the alternatives. This is scarcely even arguable; it is a matter of record. Cryobiology has always been ill-supported, and in recent years support seems actually to have dwindled, partly because of a cutback in NASA funds. And private efforts to raise research money have had very little success. In contrast, organizations growing directly out of the cryonics program have donated money to cryobiological research without the help of a single big name: these include the Cryonics Societies of America, the Harlan Lane Foundation, and the Bedford Foundation. The sums involved have so far been very modest, but they will grow with the Societies. Note, for example, that Professor James Bedford, not a very wealthy man, left $100,000 of his estate for research in cryobiology and related areas, because he was planning cryonic suspension for himself. Does it require much imagination to see how this research will fare when people are being frozen by the thousands or by the millions?

Robert Ettinger makes another important point. Cryonics does not compete with resources for cryobiology research. If anything, it makes more money available to engage in such research. What better incentive to fund research than your own life being at stake? It is not a coincidence that the field of vitrification of complex organs has received great support from cryonics advocates. This funding has culminated in the identification of the least toxic vitrification agent known in the peer reviewed cryobiology literature and the maintenance of long-term potentiation (LTP) in vitrified brain slices.

So the idea that money should be allocated to research instead of cryonics is nonsense indeed. People can have rational reasons for choosing cryonics before suspended animation has been perfected. And when they make cryonics arrangements they have a stronger incentive to contribute to research that will benefit the science and practice of human cryopreservation.

Teens & twenties cryonicist event 2010

teens_twenties_2010

This past weekend (Friday, January 8, 2010 to Sunday, January 10, 2010) I attended a meeting for cryonicists in their teens & twenties near Fort Lauderdale, Florida. The event was funded by Bill Faloon and the Life Extension Foundation. Cairn Idun, creator & coordinator of the Asset Preservation Group, created & coordinated this event as well. Although the Asset Preservation Group was created to devise means of protecting the assets of cryonicists during cryostasis, the group has expanded its concerns to many related issues, including nurturing future generations of cryonics activists to replace the current generation of aging cryonics activists.

The qualification for receiving a scholarship to attend the Teens & Twenties event was applying and being validated as having funding & contracts in place for cryopreservation with any cryonics organization, and being in the 12-30 age range. There were cryonicists from CI, Alcor, ACS, and KrioRus (the latter represented by Danila Medvedev). Some cryonicists were from Canada, Poland, Norway, the Netherlands and the United Kingdom. Altogether there were 33 cryonicists receiving scholarships, two spouses of those cryonicists who paid their own way plus 13 speakers and Members of the Asset Preservation Group (which includes me) —  for a total of 48 people attending at various times. Among the young cryonicists I believe there were only three teenagers: the two young sons of Bill Faloon, and 19-year-old CI/ACS Member Shannon Blevins,Jr.

By way of introduction, Bill Faloon described his experience of being a 19-year-old cryonicist attending the South Florida cryonics group in the 1970s. Wealthy cryonicists had sponsored him to attend a cryonics training and a life extension meeting in California. He believed that that sponsorship had paid big dividends for cryonics & life extension that he hoped would be comparable to the results of the LEF investment in this teens & twenties group for young cryonicists.

Everyone was then to give brief (under one minute) self-introductions. I won’t give many details, but there was a common theme of growing up with ideas & aspirations that were greatly different from those of friend & relatives. One young man is reputedly the only cryonicist in the state of Alabama. One young woman signed-up at the age of 16 and convinced her father to do so as well. She expressed a sentiment that many resonated with: “even individualists need a sense of community & belonging”. Before the meeting I had been concerned that many of those who had been signed-up for cryonics as young children by their parents would probably not be serious cryonicists. I was impressed by the extent of commitment to cryonics I saw among many of those who had been signed-up virtually from birth.

Although it is stereotypic that cryonicists are single, male computer nerds, 34% of these young cryonicists were female, and quite a few of them were involved with the entertainment industry. During the longer self-introductions Cairn noted five interest areas. The topics were: social networking, promoting cryonics through entertainment, cryonics-related science research, defending & promoting cryonics on the internet, and legal issues associated with cryonics. Cairn had the attendees separate into the five interest areas for discussion, and then we heard presentations from representatives of each group.

The next “getting to know you” exercise involved the participants classifying themselves by personality type as represented by the four colors green, blue, gold, and red:

Green — Conceptual, Curious, Wise, Versatile (intellectual, head rules heart)

Blue — Warm, Communicative, Compassionate, Feeling (seeks harmonious relationships)

Gold — Responsible, Dependable, Helpful, Sensible (dutiful, family-oriented, organization-oriented)

Red — Adventuresome, Skillful, Competitive, Spontaneous (seeks variety and physical involvement)

The participants were given colored sheets that described each personality color in detail as a means of assessing how much of each color composed their personality. Participants were to put various numbers of each color of dots on their name badges corresponding to how much each color is represented in their personality.

I later searched the internet for the basis of this classification system. I found some close matches, but nothing seemed exact:

http://en.wikipedia.org/wiki/Keirsey_Temperament_Sorter#Temperaments_and_intelligence_types

http://users.trytel.com/~jfalt/Ene-med/true-col.html

http://en.wikipedia.org/wiki/Myers-Briggs_Type_Indicator#The_four_dichotomies

Because most individuals are a mixture of all colors, we formed groups with others matching our dominant personality color. The largest group by far were the greens, followed by reds. There were only three blues and four golds. I felt that I had so much of all the colors that it was hard for me to choose. I finally decided that I had slightly more green and slightly less gold than the other colors. I joined the green group. Eliezer Yudkowsky regarded himself as so green that he covered his name badge with green dots. Cairn commented that greens generally predominate among cryonicists, and that she was glad to see so many of the other colors because all personality types are required for good teamwork.

On Saturday a presentation by futurist John Lobell was followed by more detailed self-introductions. I tried to tell the story of my life in five minutes. After the detailed self-introductions Catherine Baldwin gave a presentation about Suspended Animation,Inc. and Bill Faloon discussed future projects that young cryonicists should consider to further the advancement of cryonics. Bill was very concerned that there had been no dynamic spokesperson to defend Alcor against the Larry Johnson media blitz in October. Steve Valentine gave a presentation on the Timeship Project, a very expensive storage & research facility planned to store thousands of cryonics patients and transplantable organs at intermediate cryogenic temperatures (about minus 140 degrees Celsius). Although I have thought that the money lavished on this project could be better-spent in other ways, Bill Faloon is enthusiastic that Timeship will convince the world of the seriousness of human cryopreservation in a way that industrial park warehouses cannot.

Sunday morning there was a tour of Suspended Animation, Inc. followed by lunch at the SA facility. The tours were conducted in groups of ten, while the others socialized and watched digitized 40-year-old films (“Ice Men Cometh”) of Curtis Henderson & Saul Kent demonstrating human cryopreservation procedures & equipment during the early pioneering years of cryonics. After lunch there was a final “getting to know you” exercise where most of the participants moved from chair to chair having brief one-to-one conversations with most of the other participants. There were quite a number of people I had not had the chance to speak with earlier, and I found this exercise to be very helpful.

The rest of the afternoon was intended to be available for informal socializing at SA, but with people catching flights and the general restlessness it quickly became fragmented.

Overall I am very enthusiastic with how the weekend went. I made many valuable connections, as did most (if not all) of the others, I believe. It also lifted my spirits, which I also believe was a common experience. Bill Faloon wants to make this an annual event.

In the week after the Teens & Twenties event, I created a Facebook group “Young cryonicists”, and sent invitations to all of the attendee.

Early in the weekend I had asked Cairn to see who among the group did not want to be photographed. To my surprise, only one person did not. I took care not to include her in any of the pictures I took of the event. The following are a few of my photos:

Dinner at the Teens & Twenties event

Line-up for Steve Valentine to autograph Timeship posters

Danila Medvedev wears video/audio glasses that record his life
[Danila calls this Plan C for reconstruction of his personality if Plan A (life extension) and Plan B (cryonics) fail] (The glasses can record 10-12 hours of video with sound before the tape needs replacing. The batteries must be recharged at least every 5 hours.)

Participants watch pioneering cryonics films while others get tours of the Suspended Animation, Inc. facility

Young cryonicists Facebook page

A photo of some Teens & Twenties with Bill Faloon posted on Facebook by Bonnie Magee

A Facebook video of the Curtis Henderson “Ice Men Cometh” films

Cryonics in the media

The Detroit News features a story about cryonics that is a good illustration of the upward battle that cryonics faces in the media. First and foremost, this story reinforces the idea that cryonics concerns the practice of freezing dead people:

Preparation of the body is a five-day procedure. It begins with keeping the body as cool as possible before arriving at the facility, to slow decomposition. Upon arrival, the body is put in a sleeping bag, strapped to a backboard and put in a cooling box.

There is no mention of the practice of replacing the blood with a so called cryoprotective agent to inhibit ice formation in the text, but the practice is explained in a sidebar.

Then the inevitable “expert” (John K. Critser, president of the Society for Cryobiology) makes the predictable error of  offering his opinion on the feasibility of cryonics based on our current ability to achieve real suspended animation.  If a scientist cannot conceptually distinguish between a technology that is meant to halt decomposition to allow resuscitation efforts in the future and a technology that is able to cool down a complex organism and recover it with contemporary technology, cryonics has a serious “marketing” problem.

There has been much debate about how to persuade more people to consider cryonics. Renewed efforts should be made to end  misunderstanding about the following three basic points about cryonics:

1. Cryonics is not the freezing of dead people, but involves the attempt to halt decomposition of people that have been given up by contemporary medicine through the use of low temperatures. Legal death is not biological death.

2. The objective of cryonics is to protect critically ill patients against ice formation at cryogenic temperatures by replacing the blood with a cryoprotective agent. Vitrification solutions attempt to inhibit ice formation altogether.

3. Cryonics is not suspended animation and should not be evaluated as such. Expecting people to destroy their brains because suspended animation is not feasible yet is neither prudent nor caring. Our current burial and cremation practices reflect a simplistic view of death and a desire for instant gratification and closure.

ACD-CPR & the rise of the machine?

If conventional cardiopulmonary support (CPS) in cryonics is difficult to perform adequately, and impossible to sustain for more than brief periods (30-60 min) before exhausting even a 3-man standby team, this is even more the case for active compression-decompression CPS (ACD-CPS) using the ResQPump (formerly the Ambu CardioPump). Even in the conventional medical setting of comparatively brief periods of CPR before defibrillation ACD-CPR is difficult to do, let alone do well. Indeed, if ACD-CPR (in conjunction with an impedance threshold device such as the ResQPod) continues to show superior results in terms of outcome (as it is now doing in recent and ongoing clinical trials) it may be the advance that makes heart-lung resuscitators both medically acceptable and cost effective. There is some evidence that this may actually be happening; while not yet profitable, the LUCAS CPR device is gaining in popularity and continues to be the subject of consistently favourable laboratory and clinical studies.

Currently, mechanical CPS is viewed by paramedical personnel as not just dangerous (i.e., the myth of routinely broken ribs and lacerated lungs and livers) but also as ineffective and, perhaps just as importantly, as a potentially professionally demeaning or threatening piece of technology. In my 30 years of experience interfacing with EMTs and paramedics in both the US and UK regarding mechanical CPR, the most frequent remark I’ve heard is, “I can do better CPR than that machine can.” Since CPR is the most dramatic, and arguably one of the most defining practices in emergency medicine, it is perhaps understandable that many emergency medical system (EMS) personnel will equate replacement of manual CPR as equivalent to replacement of the people who perform it. Many paramedics perceive the heart-lung resuscitator (HLR) as a device that will make high quality CPR something anyone can do ‘with the push of a button.’

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In reality, deploying and applying even the most automated and technologically sophisticated HLRs will require more skill and expertise on the part of EMS personnel, not less.

Mechanically delivered ACD-CPR is also more effective than conventional mechanical CPR, even when delivered per the new AHA standards. As an example, coronary and cerebral blood flows during LUCAS CPR are improved by 25-30% over those obtained with the Michigan Instruments Thumper HLR.

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Steen S, Liao Q, Pierre L, Paskevicius A, Sjöberg T. “Evaluation of LUCAS, a new device for automatic mechanical chest compression and active decompression for cardiopulmonary resuscitation.” Resuscitation. 2002; 55: 289-299.

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Rubertsson S, Karlsten R. “Increased cortical cerebral blood flow with LUCAS, a new device for mechanical chest compressions compared  to standard external compressions during experimental cardiopulmonary resuscitation.” Resuscitation 2005; 65: 357-363

But of even greater interest in the context of cryopatient Transport is the dramatic improvement in the durability of perfusion being demonstrated with ACD-CPR using the LUCAS, as opposed to what can be achieved with conventional CPR. While mean arterial pressure (MAP) and cardiac output (CO) are often adequate to maintain cerebral viability during the first minute or two of chest compressions, they rapidly fall to levels that are inconsistent with survival thereafter. Deterioration of cardiac preload, rapid and progressive loss of chest wall elasticity (and thus recoil) and possibly elevated intrathoracic pressure from ‘auto-PEEP’ (gas trapping at the end of expiration and dynamic hyperinflation of the lungs) all likely contribute to the rapid decay in mean arterial pressure (MAP) and perfusion seen in conventional CPR.

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ACD-CPR using the LUCAS preserves MAP and perfusion, even during prolonged CPR; in one case up to 240 minutes. The representative waveforms above are from LUCAS CPR performed on 13 patients who experienced cardiac arrest during cardiac catheterization and who underwent CPR for times ranging from 45 to 245 minutes. Mean systolic and diastolic blood pressure were 81±23 and 34±21 mmHg, respectively; pressures fully compatible with preservation of brain viability and long-term survival.

Compressed Gas Bottles & the Autopulse

Aside from the problem of interrupting CPR while HLRs are applied, and the historically complex and clumsy nature of the devices, the other major barrier to the use of mechanical CPR has been the need for a bulky and heavy supply of compressed gas to power the devices. Typically, two E-cylinders containing 640 liters of oxygen or air will run an HLR for only 15 to 20 minutes. This is a major logistic hurdle in conventional emergency medicine which becomes far more serious in the setting of cryopatient Transport. Oxygen (compressed or in chemical form in ‘oxygen generators’ of the type used in commercial jetliners) cannot be transported on commercial aircraft nor shipped by common carrier because of the hazard it represents. As a result, cryonics Standby/Transport teams must find a way to acquire compressed gas immediately upon landing – something that is becoming increasingly difficult since the advent of electrically powered oxygen concentrators which have largely eliminated the need for 24/7 home delivery of oxygen in high pressure cylinders.

One solution to this problem was the development of the Autopulse (Zoll Medical Corporation) which is a battery powered HLR that delivers vest CPR. While vest CPR has been shown to be superior to conventional CPR in some studies, it lacks the ability of ACD-CPR to dramatically reduce intrathoracic pressure and to maintain MAP and CO during long duration CPR. An additional problem with the Autopulse for cryonics is that the device contains the electronics; control circuitry, motors and associated mechanical devices used to power and operate it which are located in the backboard that the patient rests upon.

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Since cryopatients are immersed in ice water, this means that the device must be extensively re-engineered for this application. Suspended Animation, Inc., of Boynton Beach, FL has reportedly developed such a portable ice bath (PIB) compatible Autopulse which they have patented and plan to market to the cryonics community at a considerable mark-up over the Autopulse’s already high retail price of ~$20,000. Another problem facing the Autopulse is the increasing gap in the quantity and quality of both the published animal and human clinical research between the Autopulse and ACD-ITD-CPR. The strong selling point of the Autopulse has been its ability to operate on compact batteries for up to 20 minutes with the ability to rapidly and easily change out batteries without any interruption in CPR.

I Sing the LUCAS Electric!

A few months ago, LUCAS announced what has certainly been a long and desperately desired advance in HLR technology – in and out of the cryonics community. LUCAS is now marketing the LUCAS 2, which is a completely battery powered version of their pneumatically driven LUCAS 1 machine.

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This second generation LUCAS uses the basic, the well-proven LUCAS 1 platform, with a number of potentially critical added improvements. In addition to using microprocessor controlled electronic actuators, the device contains a ventilation reminder; with plans to allow interface of the device to a sophisticated, compact ventilator in the near future. Most importantly, the LUCAS 2 operates for 45 minutes on the on the newly available lithium ion polymer (LiPo ) battery technology (with no test-cycles or reconditioning required) and may also be connected to and operated from electrical power points (wall outlets) or car outlets. The battery is neatly integrated in the hood of the HLR and it can easily and rapidly be changed out, making the LUCAS 2 a lightweight and compact device to store and carry (17 kg, complete).

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Incredibly important to cryonics operations is the fact that the device uses a softer start during the initial adjustment to the patient’s chest, and is much quieter when in operation. This latter consideration is of critical importance in institutional settings where the noise generated by pneumatically driven HLRs has resulted in significant resistance (and even refusal to allow their use in a few cases) on the part of hospital, extended care facility, and hospice administrators. The LUCAS 2 should go a long way towards overcoming this problem since the noise level is actually less than that often encountered when conventional manual CPR is administered.

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The LUCAS user interface remains very simple with fingertip access to all operating modes and 3-step, 3-button actuation. Delightfully, the LUCAS 2 can operate from wall current (100-240V / 50/60 Hz) or from an automobile car outlet (12-24V); if the engine is running to power the vehicle alternator, the unit can operate from the vehicle power supply indefinitely (or as long as the petrol supply lasts)!

Evidence-based cryonics

Cryonics patients can greatly benefit from rapid stabilization after pronouncement of legal death. One fortunate feature of stabilization procedures is that the most effective and validated procedures are relatively inexpensive and easy to perform.  The difference between no stabilization procedures at all and procedures that aim to rapidly restore blood circulation and drop the patient’s temperature is likely to be bigger than that between such basic stabilization and procedures that include administration of a large number of medications and remote blood washout.  This observation gains even more importance when it is considered that there is a serious lack of empirical data to support these more advanced procedures.

To date, no single neuroprotective agent has been approved for the treatment of global or focal ischemia. Despite this fact, cryonics organizations like Alcor and Suspended Animation administer an unorthodox number of medications to protect the brain and prevent impairment of circulation. While there are peer reviewed papers that combine a number of medications, there is no precedent in mainstream medicine or biomedical research in using such a large number of medications (in contemporary cryonics, medications protocol exceeds 12 different drugs and fluids). The only existing justification for using current protocol reflects work done at Critical Care Research in the 1990s. Although scattered reports exist about the effectiveness of this protocol in resuscitating dogs from up to 17 minutes of normothermic global ischemia, no detailed (peer reviewed) paper has been published about these experiments.  Another concern involves the extrapolation of these findings to cryonics. It would go beyond the general nature of this piece to document all the differences between these controlled experiments and cryonics as practiced in the real world, but suffice it to say that the factors of shorter and longer delays, longer  drug administration times, suboptimal “post-ischemia” circulation, and induction of hypothermia introduce many unknowns about the efficacy of these drugs for cryonics patients.  In the case of some medications, like streptokinase, heparin, and dextran 40, a case could be made that the potential benefits outweigh the unknowns, but should this argument be extended to all medications?

Even more complexity is introduced when cryonics organizations make an attempt to wash out the blood and substitute it with a universal organ preservation solution. The rationale for this procedure is found in conventional organ preservation and emergency medicine research. The question in organ preservation research is no longer whether hypothermic organs benefit from blood substitution with a synthetic solution, but what the ideal composition of such a solution should be. In emergency medicine research asanguineous hypothermic circulatory arrest is increasingly being investigated to stabilize trauma victims. But it is a major step from these developments to the practice of remote blood washout of ischemic patients with expected transport times of 24 hours or more. At present the only sure benefit of remote blood washout is that it enables more rapid cooling of the patient, a benefit that should not be underestimated. But when liquid ventilation becomes available to cryonics patients, rapid cooling rates will be possible without extracorporeal circulation.

The lack of relevant published data to support the administration of large numbers of drugs and remote blood washout in cryonics is not just a matter of risking performing redundant procedures. A lot of time and resources are being spent in cryonics on obtaining and maintaining equipment and supplies for these procedures, in addition to the licensing fees paid to use some of these technologies and the training and recruiting of people to perform them. But perhaps the most troublesome problem is that the preparation and execution of these procedures during actual cryonics cases can seriously interfere with rapid and effective cardiopulmonary support and induction of hypothermia.

There is an urgent need to move from extrapolation based cryonics to evidence-based cryonics. This will require a comprehensive research program aimed at creating realistic cryonics research models. It will also require vast improvements in the monitoring and evaluation of cryonics cases.  The current debate should no longer be between advocates and opponents of standby and stabilization but about what stabilization procedures should be used by cryonics organizations given our current knowledge.

Viewing cryonics as an experimental medical procedure does not necessarily commit one to the position that substantial amounts of money and resources should be allocated to recruiting medical professionals and expensive equipment. The most common sense implication of the views outlined above is that the most effective measures to improve the care of cryonics patients are encouraging members to relocate to the area of their cryonics organization, improved health tracking of existing members, and cryonics training aimed at teaching the basic procedures and techniques that confer real evidence-based benefits.

The purple prose of suspended animation

Esquire magazine features an article on scientist Mark Roth and his research into “suspended animation.” As the website title “The Mad Scientist Bringing Back the Dead…. Really” indicates, this is not supposed to be a detailed account of Ikaria’s recent advances in induction of depressed metabolism but a sensationalist piece on mad scientists. Although the piece states that “Ikaria’s first suspended-animation product” has “completed Phase 1 trials in Australia and Canada” and is “being tested on humans, to make sure it’s safe” it remains to be seen if this technology involves major advances in rapid induction of depressed metabolism in humans or offers just another treatment option for various hypoxic-ischemic conditions as the press release (pdf) seems to indicate.

The article misses a number of opportunities to set the record straight on the proper use of terminology and prevailing definitions of death. The ability to resuscitate an organism from circulatory arrest, depressed metabolism, or suspended animation implicates that the organism was not dead to start with. This is not just a matter of semantics. The phenomenon of death is surrounded by many cultural and religious taboos and the difference between saying that we can  bring back the dead instead of  observing that recent advances in science and medicine requires us to redefine our definition of death  is not a trivial matter. Most religious people do not object to cardiopulmonary resuscitation or hypothermic circulatory arrest because they do not believe that a patient who is resuscitated in such medical procedures was (temporarily) dead. The word death should be reserved for a condition in which integrated biological function cannot be restored by either contemporary or future technological means.

Increasingly, the phrase “suspended animation” is thrown around to describe a number of distinct phenomena ranging from modest drops in metabolism to complete metabolic arrest. If the word  is taken literally, however, only complete metabolic arrest constitutes real suspended animation. Such a state cannot be achieved in humans by the use of hydrogen sulfide (or its injectable derivatives) and requires either the use of extreme cold such as practiced through vitrification in cryonics or the use of advanced nanotechnology in warm biostasis.

Popular reports on recent developments in “suspended animation” do not carefully distinguish between the results obtained with hydrogen sulfide and carbon monoxide in C. elegans and mice and its applications in humans. Until more detailed information is available on the use of these substances in large animals or humans it should not be assumed  that rapid pharmacological induction of depressed metabolism in humans is a clinical possibility.

Human cryo-anabiosis

Recent advances with the use of hydrogen sulfide, carbon monoxide and “hibernation induction triggers” to depress metabolism in animal models have  renewed interest  in the possibility of human hibernation.  The ability to drastically depress human metabolism without the use of cold (or in combination with cold) would have a number of important medical and scientific applications including the stabilization of trauma patients, prolonging the time of safe circulatory arrest in surgery, and space travel.

In 2007, the author published a review of the field of depressed metabolism for Alcor’s Cryonics Magazine and expressed skepticism about the prospect of real hibernation in humans any time soon. But this does not mean that we cannot learn from natural hibernators to identify metabolic pathways that can be inhibited to prolong the period the brain can sustain circulatory arrest at normothermic and hypothermic temperatures. As evidenced by the remarkable period myocardium can sustain energy deprivation and still recover, there is still a lot about human metabolism that remains obscure.

Like many ideas in biogerontology, the idea of chemically manipulating human metabolism as a medical procedure to prolong or save lives has gone through various cycles of optimism and disillusion. In his 1969 book Suspended Animation, the author Robert Prehoda presented a number of proposals to manipulate  metabolism in humans. Another person who wrote about depressed metabolism, or “human anabiosis,” was the cryobiologist Armand Karow (1941-2007). During the year 1967 Karow wrote a 5 part series on the science and prospect of depressed metabolism in humans for Cryonics Reports which is made available for this first time online. Although Karow devotes most of his series to the technical obstacles to achieve real suspended animation using cryogenic temperatures, he also discusses the use of metabolic inhibitors to protect vulnerable organs during cooldown to cryogenic temperatures.

Armand Karow – Goal: Human Cryo-Anabiosis (1967)