Cryonics is a field that requires commercial success of some form for further expansion, such as in the reversible vitrification of organs, not least because either that or wealthier patrons than presently exist will be needed as a source of significant funding to improve current methodologies of preservation. The recent report from Alcor noted here illustrates the well-understood need for this sort of technical improvement. Alcor presents comparatively unfiltered reports on cryopreservations, where patients agree to it, and the staff and patients should be commended for this. Such reports are important to the quality of an industry, and open organizations are certainly better than closed ones.
It is arguably the case that the biggest hurdle today when it comes to obtaining an optimal cryopreservation is the illegality of assisted euthanasia, a state of affairs that forces the industry into the form of a standby and emergency response service. That makes it both expensive and challenging to achieve a high-quality cryopreservation immediately after clinical death, as a sizable fraction of deaths in late life are unexpected in their timing. When euthanasia becomes more broadly legal and accepted, however, it will then be the case that technical limitations such as access to blood vessels in stroke victims will become the biggest immediate hurdle. It is easy to envisage ways around that problem, and the more sophisticated apparatus, the better tools to get at the blood vessels of the brain at multiple points so as to introduce cryoprotectant in a controlled way during cooling. While cryonics remains a non-profit and comparatively resource poor industry, this sort of technology remains out of reach - which is why some form of commercial success is needed, to enable bootstrapping to the next level of operation.
As the example here illustrates, even when the patient's terminal decline is slow enough to organize a preservation immediately following clinical death, there are forms of death, such as those resulting from stroke, in which modern methods of vitrification cannot be used because the state of the art in the industry isn't yet advanced enough to work around significant blood vessel blockage in the brain in a cost-effective way. Vitrification requires introduction of cryoprotectant into the vascular system of the brain, and that cannot be done haphazardly. So by commonplace bad luck, the patient obtains a preservation that will introduce significant ice crystal formation and consequent tissue damage, rather than the vitrification intended to minimize that issue. That adds to the bad luck of having suffered earlier damage to the brain due to stroke and its consequences. These are all challenges that could be addressed giving meaningful investment into cryonics.
Alex Arevalo, a public, neuro member, was pronounced on October 20, 2017 in Tucson, Arizona and became Alcor's 153rd patient the same day. Alcor received an emergency text on October 20th just before 10:00 (all times are Mountain Time in 24-hour format). We were alerted that Alex Arevalo was suffering from a stroke. He had a previous stroke in January of 2017. Contact was made with Peggy, his wife. She stated he was unable to speak or to move his right hand, and suffered from right-sided facial droop. They were currently located in Las Cruces, NM and he was being transported to the closest stroke center in Tucson, AZ.
Josh Lado, Director of Medical Response, was traveling to Tucson that morning on personal business. He traveled to the hospital to which Alex had been flown and made contact with the attending physician in the Emergency Department. She stated that they had performed a CT scan and she didn't believe that the patient's brain was receiving any significant blood flow. The patient had suffered a hemorrhagic stroke at the brain stem. Josh called Alcor's Chief Medical Advisor, Dr. Harris to inform him and determine the best course of action.
Dr. Harris and Josh agreed that the patient should be taken off ventilation immediately to allow legal death by cardiopulmonary criteria to occur. He was extubated at 13:50. Josh called Dr. Harris and the decision was made not to perform any cryoprotectant perfusion once the patient was at Alcor and to perform a straight freeze. This decision was made because of the inability to perfuse the brain due to the hemorrhagic stroke and associated warm ischemia that had already occurred, and the chance that added pressure would cause more damage inside the patient's brain. Alex's vital signs significantly changed at 18:57 as his heart rate decreased, rhythm changes occurred, blood pressure spiked, and oxygen levels dropped significantly. Legal death was declared at 19:18. Alex had ice placed around the head and neck and preparations began for transport. Once paperwork was finished, hospital staff helped move the patient to the transport vehicle and assisted in moving him into the Ziegler case.
Four bags of ice were placed in the case to precool the metal box. 35 pounds of ice was added around his entire body. This was to ensure the ice wouldn't melt by the first stop just outside of Tucson. The patient left the hospital at 20:11 to head back to Alcor. The first stop to check for ice was at 20:36, and five pounds of ice was added. The second stop was at 21:33 and 5 more pounds were added. The reason for making two stops for ice was the limited space around the head for ice, between the wadded body bag corners and the case having 45 degree corners at head and foot. There was plenty of ice but Josh wanted to ensure continued cooling. The patient arrived at Alcor just after 22:30. Surgery was performed for neuro separation and cool down began right away.