Thursday, September 23, 2010

A Partial Review of Suspended Animation's Report for CI-95 (Mr. Curtis Henderson)

My apologies to the people I've been promising this to, for a very long time. I find Suspended Animation's case report to be heavily "padded" with unnecessary detail, which I probably won't ever waste my time commenting on, other than to say I think the unnecessary detail was designed to make SA look more professional, knowledgeable and capable, than they really are. These people do not know what they are doing. If they want to be a team of amateurs, simply "doing the best they can," to provide "something better than nothing," then they need to advertise themselves as such. On the other hand, if they want to publish reports filled with medical terminology, designed to deceive laymen into thinking they are capable of providing advanced medical procedures, and charge exhorbitant fees for those procedures, that is QUACKERY.

Considering the report was written, basically, for an audience of laymen, parts of it appear to be "misleading," at best. SA has a group of qualified perfusionists on retainer, so they certainly had at their disposal, people who were well-aware the "arterial" and "venous" temperatures reported were NOT patient temperatures, but perfusion circuit temperatures. SA's reporting of these temperatures, without explaining to the audience of laymen that those temperatures may be far-removed from the patient's core temperature seems, to me, to be intentional deception.

The black text, in italics, is excerpts from Suspended Animation's case report, for CI-95 (CurtisHenderson, June 2009, Albany, NY), the blue text is my comments. SA's full case report can be found, here: of SA’s consulting physicians agreed that death was imminent and a standby team should deploy.
SA has more than one "consulting physician"? What are their names and are any of them skilled in vascular cannulations?

CI was notified of SA’s deployment plans and CI offered the services of its funeral director to make pre-arrangements with a local funeral home to support stabilization and transport efforts. SA accepted this offer of assistance...
It looks like CI's funeral director did a lot of SA's work, for them.

The contract perfusion coordinator was notified of the pending case and location and began arranging coverage. A contract surgeon was contacted and arranged to deploy with the team. Back-up team members were alerted.
Whom does "contract surgeon" refer to? A vascular surgeon? A veterinarian? Someone who works in medical research, but really doesn't know how to perform vascular cannulations? SA is said to have used one of their "contract surgeons," (someone who is not really a surgeon, at all), for another (Alcor) case, at about the same time as the Henderson case, and that person is said to have blundered the cannulation, cutting well into the abdomen, while trying to perform a femoral cannulation.

A vehicle was rented to accommodate stabilization
equipment and procedures en route to the funeral home.

Just out of curiosity...Was that vehicle a van, or maybe even a "box truck"? (When Larry Johnson mentioned the use of a "box truck," in his book, I believe Alcor's attorneys referred to his remarks as defamatory. Do Alcor's attorneys think the use of such a vehicle is something to be ashamed of?)

One SA staff member departed that afternoon and the contract perfusionist arrived in the evening.
Why did the staff member depart, and why doesn't SA have at least one perfusionist on staff?

The contract surgeon departed because of work obligations. A second contract surgeon was scheduled to arrive early Thursday afternoon. Another SA staff member arrived to replace the one who left.
Why are all these people coming, and going? With so much time on their hands, and so few cases, this is totally ridiculous. SA has SERIOUS PERSONNEL ISSUES, the main one being that, as far as anyone knows, NOT ONE of their full-time staff members is qualified to do a vascular cannulation, or to perform perfusion, (the key ingredients of the high-priced services they sell). To have a payroll and employee-related expenses in the high six figures, without so much as ONE staff member being qualified to perform the medical procedures a company is selling, is simply ludicrous.

Again, what were the qualifications of the "contract surgeon"?

The patient suffered cardiac arrest and was subsequently pronounced legally dead by the attending Hospitalist at 4:17am.
Note the time.

Over the next 20 minutes, the following medications were administered via IV push...
Who administered these medications? Was it legal for the Albany, NY hospital to allow cryonics personnel to do so? Was it legal for even hospital personnel to push meds, after death had been pronounced?

A nasopharyngeal probe and rectal probe with thermocouples were inserted and the patient’s Foley catheter assembly was removed.
Who inserted the nasopharyngeal probe, and was it properly positioned? (Throughout the case report, I wondered whether the probe was being influenced by room temperature and/or water from the ice bath.)

At that point the patient’s temperatures were approximately 30 C nasopharyngeal and 38 C rectal.
The nasopharyngeal temp is still warm, (about 86F). Rectal temp is quite warm (100.4F).

Team members continued to administer Tromethamine and Epinephrine IV push during transport.
Again, is it legal for laymen to administer medications to the deceased, in New York?

Nasopharyngeal temperature was 25C, rectal temperature was 36C. The sample analysis results are shown in the table below.
Approximately 90 minutes after pronouncement, CI-95's core temperature was still 36C, (normal being approximately 36.5 - 38), in spite of SA's efforts. Brain death occurs within minutes, at normal body temperature.

pH 7.324
PCO2 mmHg 29.7
PO2 mmHg 6
Sample Type Ven
PtTemp 25.0 (77F - still pretty warm.) Did SA selectively report the coldest of the two temperatures they were recording?

Arriving at the funeral home at 6:35am, the patient was moved from the vehicle into the facility’s small embalming room.
Note time is 6:35am, when SA arrives at mortuary.

The funeral director had not arrived at the facility. The Team Leader prepared the patient’s right groin for surgery by swabbing with ChloroPrep and draping with sterile towels. The approximate location of the femoral artery and vein was determined referencing the midpoint along the inguinal crease between the pubic symphysis and iliac crest."
This looks like someone reciting from a textbook, rather than someone who actually knows how to locate the femoral vessels, and perform a vascular cannulation...technical mumbo-jumbo, from people who are not qualified to attempt these procedures in real life.

Using a #10 scalpel blade an 8cm incision was made at this midpoint, just below the inguinal crease along the longitudinal axis of the leg. Blunt dissection and electro-cautery were used to clear a 3cm layer of heavy adipose tissue to expose the muscle. Additional blunt dissection clearing 2cm layer of muscle was made through heavy pooling of bright red blood from the surrounding tissues. Hemostasis with surgical sponges was ineffective. After 20 minutes of dissection the femoral capsule and vessels were not visible and a consulting physician was called.
More padding, and incompetence at its best. SA's personnel, who don't know what they are doing, are asking for advice on how to perform the surgical procedures they are selling...from someone over the telephone, no less.

He suggested additional adduction of the thigh.
You have a group of people, who don't seem to have a clue as to how to find the femoral blood vessels, (some of the largest blood vessels in the human body), and the physician they call tells them to move the leg toward the midline??? You've got to be kidding me. Greater femoral access is gained with ABDUCTION (the opposite of what was recommended to SA), and external rotation. Did Harris, (the physician who seems to know little about vascular cannulations and perfusion, as performed in conventional medicine), make this recommendation? (Anyone willing to take a bet that whoever made this recommendation will claim, "I said ABduction," or SA will claim it was a typo?)

An affiliated funeral director arrived and was able to direct movement of a muscle mass and identify the vessels before he also left.
This is crazy. A bunch of clueless people, attempting to perform surgical procedures, taking advice from someone over the telephone, when a funeral director, (who obviously doesn't want to have much of a hand in this mess), walks in and says something like "Try looking behind that muscle." Baldwin can recite all the textbook instructions she wants, and call herself a "backup surgeon" (when she's not a surgeon at all), but she did NOT know how to FIND the femorals, much less cannulate them properly.

The vessels were then isolated, separated and cannulated. The vein was 4-5mm in diameter, dark, thin walled, and fragile. Blood flowed freely from it during cannulation. It was ultimately cannulated with a 15 Fr venous cannula inserted approximately 22cm, after attempts to place larger 21 Fr and 19 Fr were unsuccessful. Nearly over the top of the vein, was the artery with multiple feeder vessels between the two. The artery was 6-7mm in diameter, light colored, rubbery and heavy walled.
Again, this looks like someone is writing from a textbook, and only a further demonstration of SA's extreme lack of competence.

Bright red blood flowed freely from it during cannulation. It was cannulated with a 17 Fr arterial cannula inserted approximately 12cm after attempts with a 19 Fr cannula were unsuccessful.
More incompetence.

The cannulae were connected to the extracorporeal bypass circuit on the Stockert SCPC minibypass system that had been primed with MHP2 organ preservation solution and cooled by the perfusionist. No venous drainage was observed.
The cannulation wasn't performed properly. The SA personnel didn't know how to perform their procedures, in spite of having had seven years, and probably close to seven million dollars, to prepare, for this case. This is QUACKERY at its best.

No bubbles or air locks were visible in the circuit.The perfusionist applied mild suction and the AutoPulse was re-started to assist with drainage. Still, no venous return could be seen. The venous cannula was slowly backed out while applying suction and automated chest compressions but no return was visible. Nasopharyngeal temperature was 15C and rectal was 25.6C.
At a core temp of 25.6 (abt 78F), a safe circulatory arrest time is somewhere in the neighborhood of 20 - 30 minutes. How many hours did SA have Mr. H. at 25.6 and above? Even at 18C, standard perfusion guidelines call for no longer than 60 minutes of arrest time.

A call was made to CI to determine additional site options for cannulation. A jugular cannulation would not interfere with cryoprotection procedures. The patient’s head was repositioned to the contralateral side and the neck swabbed and prepped for external jugular vein cutdown. The AutoPulse was started to aid location of jugular vein. Pressure to the platysma muscle did not create any obvious jugular pooling. Identification of the external jugular was then made using the mid-point between the angle of the mandible and the top of the clavicle.
Suspended Animation's manager and pseudo-surgeon, Catherine Baldwin, butchered Mr. Curtis Henderson, making at least three incisions, unable to perform a vascular cannulation. More textbook recitations from people who don't know what they are doing.

Using a number 10 scalpel blade, a 3cm incision was made and blunt dissection used to clear the tissue. The jugular was not immediately visible. A call was made to the funeral director about shipping options and additional surgical assistance.
People who require instruction, for surgical procedures, (via telephone, no less!), have no business performing these procedures, much less calling themselves "surgeons."

Flight options to accommodate human remains cargo at this time would be limited to Newark Airport.
I've been told at least two booked flights were missed, while hours passed, and this report indicates Mr. Henderson was at rather tepid temperatures, for much of this time.

An affiliated funeral director would be available to come to the facility in thirty minutes. Additional ice was packed onto the patient. The Ziegler case was delivered by van at 11am.
Note time: They've been at the mortuary for three-and-a-half hours, and they haven't performed a procedure that should take minutes.

A funeral director affiliated with the funeral home arrived and offered to quickly cannulate the femoral vein on the patient’s left side. Opening an 8 cm incision and using an aneurism hook for dissection, his field quickly filled with bright red blood. He located the femorals but in separating them, he accidentally cut the artery and multiple feeders between the artery and vein. These vessels were individually ligated and the wound packed while the funeral director enlarged the jugular incision that had been opened earlier and isolated the jugular. A 17Fr venous cannula was inserted into the jugular vein approximately 30cm and connected to the venous perfusion line. Mild suction was applied. Venous drainage was observed.
At last, some success. A funeral director, (someone who is probably not accustomed to performing vascular cannulations with the same degree of care as a vascular surgeon), appears to have managed to do, in a short period of time, what Baldwin/SA had not been able to accomplish in many hours.

Washout started at 12:11pm. Nasopharyngeal temperature was 11.8C and rectal temp was 23.6C. (74.5F)
After a short period of perfusion, a tourniquet was applied above the left leg wound to minimize leakage of perfusate from this area. To conserve additional perfusate, a second tourniquet was applied with light compression on the tissue around the arterial cannula on the right leg.
No one there knew how to perform a good cannulation, one of the key ingredients of doing a cryonics washout procedure.

Twenty minutes after washout was initiated, arterial temperature was 4.6C and venous temperature was 13.3C
When addressing an audience of laymen, it is DECEPTIVE to write " the arterial temperature was 4.6C and venous temperature was 13.3C." These temperatures are perfusion circuit temperatures and DO NOT reflect patient temperatures. What they are calling an "arterial temperature" is the temperature coming out of the heat exchanger in the perfusion circuit, and what they are calling the "venous temperature," is the venous line of the perfusion circuit.

Let's say I have a patient in heart surgery, with a normal body temp. I hook him up to a perfusion circuit. His blood drains into the perfusion circuit, passes through the heat exchanger, and in a relatively short period of time, I am able to return that blood to him, at a temp of 4.6C, and the blood coming back to the perfusion circuit is 13.3C. I could accomplish that, in a very short time, but guess what? The patient may still be quite warm. If I were to turn off my heat exchanger, as soon as I saw a perfusion circuit venous return line temp of 13.3C, the patient would rewarm the blood in my circuit, and those temps would rapidly rise. CI-95's core temperate WAS NOWHERE NEAR THOSE TEMPERATURES.

Think of it this way. You have a hose, running through a bathtub filled with water at 37C. You start flowing cold water into the hose, and pretty soon the water coming out the other end is also cold, but the water in the tub is still warm. This is a very simplistic example, but I'm sure intelligent readers understand that someone could flow extremely cold fluid through a person's circulatory system, for a very short period of time, while most of their body tissues would remain warm. Again, SA is being deceptive in reporting these "arterial" and "venous" temps. These were NOT Mr. Henderson's arterial and venous temps, but those of a perfusion circuit.

After 23 minutes on washout, about 14 of 28L of MHP2 had been used and the circuit was closed for cooling recirculation. The remaining perfusate was added slowly during recirculation to maintain circuit volume. After an additional 20 minutes on closed circuit, arterial temperature was 1.7C and venous was 9.5C.
GROSSLY MISLEADING. Again, these are perfusion circuit temperatures, not patient temperatures. The patient was, most likely, significantly warmer than either of these temperatures.

Perfusion was stopped about five minutes later when the last of the perfusate had been used. There was no longer visible edema in the patient’s upper or lower limbs. There was no visible change in abdominal distension. Arterial temperature was 1.7C and venous temperature was 8.5C. Nasopharyngeal temperature was 8.7C and rectal temperature was 17.5C. The patient’s cooling curve is shown below.
The rectal temp of 17.5C reflects the core temp of the patient. The guidelines for a safe period of circulatory arrest, (one which is unlikely to result in neurological damage), at this temperature, is 45-60 minutes. SA should have continued cooling until ALL the temperatures were as close to 0-degrees C, before ending the perfusion process and transporting. Instead, they took Mr. Henderson on a long car ride, at temperatures known not to sustain cerebral function for an extended period of time.

The patient was disconnected from the extracorporeal bypass circuit with the cannualae clamped and left in place.
Question for CI: Is this correct. Wasn't one cannula missing?

That's enough, for now. There's more to be added, later, but I can't resist skipping ahead to remark (again) on this:

• Arrangements for airline cargo movement of the kits were made the evening before deployment. When the team arrived at the air cargo office at 5am, the agent would not accept the kits because they did not have SA’s federal shipper number, account number and had no air bill for the kit, with these numbers included.
Why would anyone expect people who are not capable of shipping packages to be able to perform surgical procedures and perfusion? For SA to have overnight to prepare, and then show up at the airport, without everything they needed to get their equipment transported is far-beyond incompetent. At the time of this case, they had had seven years, and had probably spent in excess of seven million dollars, to prepare, yet they hadn't even managed to become proficient in transporting their equipment? That's the most simple part of the services they are said to be providing!

Attempting to check the kits as luggage, Continental Airlines would not accept two of the Pelican cases containing the ATP and the MHP2 perfusate because they exceeded maximum allowable weight limits.Two team members stayed behind to make shipping arrangements for the remaining kits, while three team members flew on to Albany. Two team members were delayed by 4 hours and critical kits were delayed by 12 hours.
These people don't have enough sense to get luggage on a plane, much less preserve a brain in a condition that will be viable in the future.

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