New Horizons in 21st Century Life Extention
The Cryonics Institute's 110th Patient
by Ben Best
The 110th patient of the Cryonics Institute (CI) is an 82-year-old woman whose primary occupation was chef, including at a restaurant that she started herself. She and her husband divorced after having a daughter, but the couple re-united and lived together for 20 years without remarrying. The ex-husband and daughter tended to the patient during her terminal illness — and assisted with cryopreservation. The ex-husband encouraged the patient to make cryonics arrangements with CI, and the patient agreed.
The patient had been a chronic smoker most of her life. In the mid-1990s the patient had fainted at home due to congestive heart failure, and was soon thereafter given a stent and a pacemaker. The patient stopped smoking "cold turkey" at that time, at the urging of her cardiologist. About three years prior to 2012, part of a blood clot in the left leg went to the lungs. The clot in the lungs was broken-up with medication. The clot in the leg was surgically removed, and a stent was placed in the leg. The patient was also given a defibrillator.
As a further complication, not long before the patient's problem with the clot in the leg, the patient had received methotrexate for treatment of a severe case of psoriasis. Subsequently, the patient developed mantle cell lymphoma, quite possibly as a side effect of the methotrexate treatment. A round of chemotherapy was given at the beginning of 2011, followed by a second round of chemotherapy in the summer of 2011. Because the chemotherapy compromised the capacity of the patient's bone marrow to produce platelets, the patient began to receive platelets and blood transfusions. The chemotherapy eliminated a cancerous lymph node next to the colon, but radiation therapy in January 2012 was required to subdue cancerous lymph nodes that were constricting the patient's windpipe and esophagus.
Early in 2011 when the ex-husband was thinking about cryonics for the patient, he placed an advertisement in a newspaper looking for medical personnel who could assist. He was contacted by a nurse who I will call "cryonurse" because of her interest.
The patient reportedly was not eating because of the lymphoma, which contributed to a vicious cycle of malnutrition, weakness, and exacerbated congestive heart failure. The patient had been mostly at home until this time (early in 2012), but subsequently required more intensive treatment at hospitals and rehabilitation centers. The patient's ex-husband and daughter were spending much time at hospitals and rehabilitation centers assisting with feeding, cleaning and care of the patient. Cryonurse was hired early in 2012 to assist them.
The patient's ex-husband was determined to ensure that the patient received the best possible cryonics care. Not long after I told him that the best treatment involved coming to Michigan, he began looking for ambulance companies that would make the trip. Many of the companies simply refused to drive a patient across several states in a trip to Michigan. A second problem was that there needed to be a physician in Michigan who would accept the patient. Having been informed that the hospital nearest to the Cryonics Institute is McLaren-Macomb Medical Center, the patient's physician was able to persuade a physician in the emergency room of that hospital to accept the patient. The patient was given a round of platelets and a blood transfusion to enable her to endure the stress of the trip.
On Thursday, March 29, 2012 at 6 P.M. the patient arrived in the ambulance to the emergency room of the McLaren-Macomb Medical Center, but the physician who had agreed to accept the patient had gone on vacation — which resulted in a delay of several hours before the patient could be transferred from the emergency ward to a hospital room. The patient had been greatly weakened by the trip to Michigan, and was not expected to survive the weekend. After some resistance, the hospital gave the patient a double-dose of platelets, which may have contributed to her recovery. The hospital was very accommodating in allowing the patient's ex-husband and daughter to stay with the patient in the hospital. Cryonurse, who had accompanied the patient in the ambulance, also assisted. The ex-husband and daughter slept in a nearby hotel on alternate nights. Cryonurse remained with the patient, also sleeping in the hotel on alternate nights.
Part of the plan for bringing the patient to Michigan was that the patient could use Robert Ettinger's house for hospice care, as was done for the cryopreservation of Robert Ettinger. The house was to be sold, but was unoccupied. David Ettinger (Robert's son) agreed that the house could be used for cryonics/hospice purposes by the patient. The portable ice bath, thumper, and oxygen tanks had been moved to the house for that purpose. On the weekend, I gave cryonurse and the patient's daughter a tour of the house so they could assess the set-up.
On Wednesday, April 4th I met with hospital administrators to discuss the situation. The patient's daughter and ex-husband attended some of the meeting. The administration was mostly negative about their hospital being used for palliative care or cryonics. Post-mortem heparin, chest compressions, and application of ice was not part of services the hospital was authorized to offer. The administration wanted the patient removed from the hospital the next morning.
The patient's daughter, who had more legal authority than the ex-husband, wanted her mother to remain in a hospital setting. If the patient was to be removed from the hospital, she preferred for the patient to be in an extended care facility with hospice services, rather than in Robert Ettinger's house under hospice care. Not long after the meeting, however, the hospital acknowledged that the patient was too ill to be moved because of the danger that the stress of the move would cause the patient to die in the ambulance. I took three coolers full of ice to the hospital.
The patient's condition continued to deteriorate. The patient was still being given Lasix to remove fluid associated with the congestive heart failure, and potassium to restore losses due to the Lasix. Although the lungs were filling with fluid, the patient was given a "do not suction" order. More that one physician phoned me expressing concern that heparin would cause bleeding in the brain due to the low platelet level. I had doubts about this, but to confirm, I phoned cryonics physician Dr. Steve Harris, who reminded me that with blood washout cryonics patients typically have no platelets whatsoever, but nonetheless maintain blood vessels intact. A scientific understanding of cryonics science would indicate that bleeding in the chest due to vigorous chest compressions would not affect cryonics procedures.
The nursing staff proved to be highly supportive, with many of them reportedly hoping the patient would deanimate on their shift. Not long after midnight on the morning of Friday April 6th, a nurse told the patient's daughter and ex-husband to quickly come and say goodbye to the patient, as the patient's eyes opened. They both said "I love you". The patient then closed her eyes and deanimated. A physician was present to immediately pronounce death (at 12:55 A.M.), heparin was administered, and within one minute there were about fifteen nurses in the room taking turns doing aggressive chest compressions, and adding ice. A towel with ice was placed around the head. Chest compressions were continued for exactly 15 minutes, after which the patient was placed in a body bag of ice and water. (A whole gurney full of ice was brought into the room.) Because I had stressed that a mixture of water and ice in a body bag gives better cooling than ice alone, the physician who had pronounced death assisted the nurses in bringing water in a pan. The small size of the patient (about 5 feet tall and about 110 pounds) meant that the cooling was very efficient.
Funeral director Jim Walsh was awakened and promptly drove to the hospital. Hospital staff were accommodating in allowing him to come to the patient's room — a practice that is normally not allowed.
The patient arrived at the Faulmann & Walsh funeral home at 2:15 A.M. The patient was placed on the operating table, with ice packed around her head. Surgery began at 2:37 A.M. Mr. Walsh was somewhat reluctant to open the chest for a patient with a defibrillator, but he did so — removing wires in the process. He observed that the aorta was sclerotic, but was firm and the ascending aorta held the cannula [Elongated One-Piece Arterial (EOPA) Central Arterial Pressure (CAP) cannula] without breaking. The descending aorta was clamped, but only the right jugular vein was opened for drainage. Later a nasopharyngeal temperature probe was inserted.
The patient was perfused with 5 liters of 10% ethylene glycol and 5 liters of 10% ethylene glycol, but flow rate was over 1.0 liters/minute and pressure was over 100 mmHg. Perfusion with CI−VM−1 vitrification solution began at 3:04 A.M. The CI−VM−1 was at freezer temperature (about −20ºC) in contrast to the ethylene glycol, which was at refrigerator temperature (about 3ºC). Flow rate was still high for the amount of perfusion pressure, and the refractive index of the venous effluent was not changing — despite the fact that the patient's head showed good dehydration.
Mr. Walsh thought that the clamping of the descending aorta was poor, and that fluid was being lost to the body, so perfusion was halted at 3:20 A.M. and the carotids were cannulated with steel cannula. The patient had received 15 liters of CI−VM−1.
|EOPA CAP Aortic Cannula||Steel Carotid Cannulae|
Perfusion was resumed at 3:30 A.M. Immediately, the refractive index from the right jugular was higher, and continued to climb. The flow rate was more appropriate for the amount of perfusion pressure. Perfusion continued for nearly an additional hour, resulting in the patient receiving nearly 30 liters of CI−VM−1. Mr. Walsh believed the quality of perfusion for this patient was extremely good — comparable to the cryopreservation of Robert Ettinger.
Mr. Walsh evaluates perfusion quality on the basis of dehydration, which is more appropriate for glycerol than for CI−VM−1. Vitrification perfusion should have a "shrink/swell" cycle — initial dehydration as water leaves body tissues followed by "rehydration" as vitrification solution replaces water in the tissues. In the latter stages of perfusion Mr. Walsh observed rehydration in the face of the patient.
RJVRI = Right Jugular Vein Refractive Index
Refractive Index values only taken during CI−VM−1 perfusion
As usual, dry ice pellets in an isopropyl alcohol slurry has been packed around the patient's head at the funeral home, and was removed at the CI facility. At the CI facility the head enclosure and dry ice was removed. Patient cooling in the Omega computer-controlled cooling box began at about 6 AM Friday morning.
With the 95th patient CI adopted a protocol based on principles outlined by a cryobiologist. This includes the idea that holding periods ten or twenty degrees above glass transition temperature can provide significant stress relief because the viscosity and thermal stress can be very high at those temperatures. Also, cracking at higher temperatures results in larger, but fewer cracks than cracking at lower temperatures. So if cracking is inevitable, it is better to force cracks at higher temperatures by rapid cooling. Unlike with the previous controller, however, the Omega controller cannot cool any slower than one degree Celcius per hour. Thus, the modified cooling protocol of the cryobiologist was:
cool as fast as possible to −100ºC
hold at −100ºC for 24 hours (stress relief)
cool from −100ºC to −110ºC in 30 minutes (10ºC/hour)
hold at −110ºC for 24 hours (stress relief)
cool from −110ºC to −120ºC in 30 minutes (10ºC/hour)
hold at −120ºC for 24 hours (stress relief)
warm from −120ºC to −116ºC in 1 hour (annealing)
hold at −116ºC for 2 hours (annealing)
cool from −116ºC to −145ºC in 30 minutes (rapid-cooling cracking step)
cool from −145ºC to −196ºC in 51 hours (1ºC/hour)
(For a more detailed explanation of these principles, see STRESS & STRAIN AT LOW TEMPERATURE and COOLING PROTOCOL NEAR Tg FOR VITRIFYING CRYONICS PATIENTS.)
Cooling was finished at about 2 P.M. on Wednesday, April 4th.
CI's 110th patient became the first patient to occupy cryostat HSSV−6−13.