There's a syndrome I'm well-familiar with, in cryonics. It's a tactic used by many cryo-employees and cryo-consultants, to make others think they know more than they really do, in regard to the conventional medical technologies related to cryonics. Since almost day one of my venture into cryonics, when discussing perfusion, (the technology used to sustain patients during open-heart surgery, and to deliver the washout and vitrification solutions in cryonics), I've been met with the question, "What about microbubbles?"
What about 'em? They're in every perfusion circuit, and there's not much we can do about it. It's highly debatable microbubbles are even worthy of discussion, in mainstream conventional medicine, and they certainly shouldn't be discussed in cryonics, where patients are still, frequently, being filled with massive amounts of air that can be seen with the naked eye. (Which reminds me, one of the world's leading cryo-experts recently wrote about "seeing" microbubbles in some tubing, but that's impossible, as they are "micro"scopic by definition.) Some of the world's leading research scientists have been addressing this issue, for decades, without resolution, so it's unlikely any of the great minds in cryonics is going to resolve it. Why are people who can't eliminate large visible amounts of air being pumped through their patients' vascular system concerned with microbubbles?
Perfusion circuits are dry, before they are primed, and thus far, it's been found to be humanly impossible to get rid of ALL the air. We can minimize the number of microbubbles, but we can't get rid of them, completely. Every patient who is put on a heart-lung machine is, no doubt, subjected to microbubbles. According to the American Heart Association, there were 694,000 open-heart procedures in the US, in 2006.
Given that only a very small percentage of patients qualify for "off-pump" procedures, probably more than 650,000 patients, in 2006 alone, were subjected to microbubbles. I believe the mortality rate in 2006 was probably three percent, or less, (and, keep in mind that the bulk of the patients who don't survive are the emergency cases, not the scheduled cases). Three percent of 694,000, is about 21,000. How many of the approximately 21,000 patients who died had their cause of death listed as being due to micro-air emboli? My guess would be "NONE." Yes, micro-air emboli are thought, by some, to cause neurological sequelae, most likely minor memory problems that resolve, on their own, over a short period of time.
"Air bubbles of less than 30 milliliters are thought to dissolve into the circulation harmlessly. Small volumes do not result in readily detectable symptoms, but ongoing studies hypothesize that these "micro-bubbles" may have some adverse effects." http://en.wikipedia.org/wiki/Intravenous_therapy
Even if they do have adverse effects, the fact remains that the discussion of microbubbles is irrelevant, in cryonics, where large amounts of visible air are said to have been introduced to a significant percentage of cryonics patients.
I think the "What About Microbubbles?" Syndrome is a concerted effort, on the part of certain individuals, to convince others, (and perhaps themselves), that they are more knowledgeable than they really are. For quite some time now, I have been attempting to get patient care providers in cryonics to avoid pumping gross amounts of air to their patients, and to quit subjecting their patients to inappropriate pressures, (whether too high, or too low). In response to some of my criticisms, I get back nonsense like this:
Michael "Mike Darwin" Federowicz:
"Ms. Maxim speaks of inappropriately high perfusion pressures in cryopatients. I concur, but would go further and ask these questions of her:
1) What are the safe and appropriate pressures to use in cryopatients during both blood washout and subsequent asanguineous recirculation? Please explain why you have chosen the value(s) you provide.
2) What are the absolute and relative medical contraindications to in-field TBW for cryopatients? 3) What are medical indications and contraindications for extended (> 1 hour) asanguineous extracorporeal support of cryopatients? What are the likely complications and how should they be managed?
4) What are the expected pressures (MAP & CVP) and flows in both acute TBW and ECMO treated cryopatients?
5) What colloids can be used in TBW/ECMO of cryopatients and for what reasons? What colloids are known to be contraindicated and on the basis of what evidence?
6) What FiO2 should be used during TBW and/or ECMO in cryopatients? Why?
Mike's questions fit one of those debate fallacies I can never remember the names of. Instead of addressing the issues at hand, he wants to take the discussion to a level the audience won't understand. No one with an ounce of common sense would expect cryonics organizations that can seldom do a washout or vitrification without pumping visible amounts of air, or subjecting the patient to inappropriate pressures, to address these issues. It's just more "smoke and mirrors." To discuss these issues with most of the people currently employed at organizations like Alcor and Suspended Animation would be rather like standing in the dark ages, trying to discuss rocket science with cavemen. (No offense, Geico.)
Could I discuss these issues with Mike, or others? Some of them, but I believe most of the answers are unknown, at this point in time. At any rate, it would be pointless to discuss this topic, (or other unresolved, complex issues), with an audience of laymen, when with most of the people working in cryonics don't even have the background required to address these issues. How about we just try to get the current cryonics care providers to quit pumping air that can be seen, and stop subjecting stroke patients to inappropriate perfusion pressures, for starters? Maybe we should precede that by eliminating "cryo-babble" which probably causes much more harm in cryonics, than microbubbles.
Of course, if Saul Kent would use the nearly three-quarters of a million dollars a year I estimate he is spending (LEF's money) on SA personnel and consultants, (mostly laymen with little-to-no medical education, or experience), to hire professionals who already know the basics, he wouldn't have to start from ground zero. Add the money he's throwing at CCR and Alcor, and we could have MANY competent standby teams spread out across the country. Instead, we have absurdities like Ms. Baldwin and her mostly under-qualified, inexperienced staff, riding around in the SA cryomobile, attempting to teach other laymen to perform medical procedures on pigs. When are cryonicists going to get tired of organizations like SA making them look like a bunch of fools?
***Note: The two posts immediately prior to this one have been updated.