First, my apologies to 'Desert Rat' for mistakenly attributing the quote to him about blue collar workers that was instead from 'George.'
To the best of my knowledge the person operating the CPB circuit on CI-81 was not a metal fabricator, but was an individual with a college degree (BA or BS) and prior experience working for a major biopharmaceutical company in a technical capacity. I do not have the CV at hand, so I cannot comment further.
On 03-06-2006 I submitted an evaluation of SA made subsequent to a 5-day visit there. I was not able to draw many conclusions about personnel due to time constraints (at that time SA was run on a 9 to 5 basis and the only two people who had a deep enough interest in cryonics (or a high enough tolerance to stomach me
) to kibbutz with me outside of SA (after hours) were Aschwin deWolf and Mathew Sullivan. I did, however, form some impressions. Only one SA employee created a sufficiently negative impression for me to comment at length. This person was the individual who was, as I understand it, subsequently operating the TBW equipment during CI-81. This is what I had to say about this individual at that time, referred to below as REDACTION 2, in my report:
"I had only brief contact with an employee named REDACTION 1, and the employee who has been hired to assist with implementation of whole body vitrification, REDACTION 2. REDACTION 1 seemed attentive and intelligent. REDACTION 2 made a strong negative impression on me. REDACTION 2 was an essential participant in several discussions relating to Standby and vitrification procedures and equipment. This person appeared bored, rarely asked questions, and left every meeting without notice and without being dismissed. I had two opportunities to speak with this person semi-privately and on both occasions I found the individual uncommunicative and profoundly incurious. I witnessed, and eventually participated in, a conversation between REDACTION 2 and REDACTION 3 relating to Hepatitis A and B vaccination and possible pneumonia (Penumovax) vaccination. I was told that REDACTION 2 formerly worked at REDACTED or a similar biotechnology business. I was thus very surprised to hear REDACTION 2 equivocating about Hepatitis vaccination. I took the opportunity to walk down the hall and watch, and ultimately participate in, the exchange between REDACTION 3 and REDACTION 2. REDACTION 2 seemed uncomfortable and perhaps adverse to the idea of vaccination and questioned why it was necessary. REDACTION 3 stated that vaccination was REDACTION 2s choice and tried to explain why it was desirable. I noted that HAV and HBV vaccinations were now mandatory for all children attending school in many states and that the American Academy of Pediatrics now considers both of these vaccinations as essential to proper childhood immunization. The way REDACTION 2 behaved in response to these and other challenges made me very uneasy. While I cannot reasonably state in full while I feel this way, my impression of REDACTION 2 is that at best this individual holds cryonics and SA in contempt."
To be fair I should note that this impression was strongly challenged by SA management, including by Aschwin deWolf, whom I respect enormously. They stated, correctly, that my evaluation was not rigorous, not sufficiently fact based, and not followed up by more aggressive interaction with the individual in question. Fair enough.
Perhaps what I should have said was that it had been my invariable experience over nearly 40 years of involvement in cryonics that people who are going to be quality, reliable caregivers are invariably engaged and interested; they have many questions and they ask them. Yes, sometimes excellent people are shy or afraid of asking a 'stupid' question; but they are nevertheless attentive and engaged. The seeming indifference of most of the SA staff, and especially this one person, was, to me at least, striking. Perhaps they thought I was a boring, pedantic jerk? I'm sure I can be.
And that brings me to George's 'challenge:'
"Melody Maxim took the time and publicly posted her thorough technical evaluation of the CI-81 report and of the revised follow-up by SA. You as highly qualified person in this area should also do so and post the results, rather than aimlessly harp on a side issue whether it should be blue collar, or metal fabricator. If you disagree with the published review, then publish your own version. Or are not you capable of it?"
Sure, I could SPECULATE till the cows come home about that case, but absent access to the people present (and their honest answers) and the relevant records (or lack thereof) thats all I could do. My speculations and suspicions broadly track some of those Ive seen made by Melody Maxim, but all that means (at most) is that the interested parties, in this case CI and the family, may want to try to get definitive answers. They alone have the standing (power) to do that. If they are satisfied, then that is pretty much the end of the story for the time being. My experience is that minding other peoples' business for them is invariably unwelcomed and unrewarding.
A much better and more relevant question to ask me (that was not asked by anyone here, even though it was handed to you), would have been: 'What are the currently understood contraindications to TBW or to extended in-field (pre-cryoprotective perfusion) extracorporeal support of cryopatients?' I asked Ms. Maxim to answer that question as self-professed expert on cryopatient perfusion and she ignored it. Here is my answer:
"The total number of cryopatients subjected to TBW of any kind is, by conventional medical standards, microscopic. There are no randomized, controlled clinical trials of any kind, let alone ones with robust numbers of patients. This must give us pause in formulating iron-clad or hard and fast guidelines in administering extracorporeal support; clearly we have a lot to learn. Nevertheless, we have to proceed on the basis of the best evidence available to us; and it especially behooves us to pay attention to that evidence when the signal is very strong. By way of example, five tests of a new drug are not very many, but if all the animals drop dead the results certainly command attention and commend caution.
In cryopatients undergoing TBW the presence of the following factors has invariably been associated with subsequent severe cerebral edema during CPA perfusion; edema much more serious than that observed in patients with comparable injury who were not given TBW:
1) Pre-existing acute CNS injury with cerebral edema such as acute CVA (stroke) and post-ischemic encephalopathy (brain injury following cardiac arrest). There is currently no (known to me) experience with blunt force or other mechanical trauma to the brain, however in cases where the injury has had time to mature into cerebral edema (activation of the immune-inflammatory cascade) it would seem reasonable to also exclude these patients as candidates for TBW or extended pre-CPA extracorporeal support.
2) Normothermic ischemia of 1 hour or more in duration.
In such patients (per above) the operative rule appears to be that we get one bite at the apple of perfusion, meaning that we use what perfusion time we have for either TBW or for CPA perfusion. It is worth noting that this has been CIs experience as well and this was cited by CI President Ben Best as one of the principal reasons that CI discontinued in-field TBW.
CPA perfusion begins with profoundly hyperosmotic perfusate which more or less relentlessly increases in osmolality as the CPA concentration is increased. The diffusion/equilibration time of CPA into/with cells is many times slower than that of the osmotically driven diffusion/extraction of water from cells. Thus, even if there is developing interstitial edema (accumulation of fluid between the cells due to damaged capillary integrity) the persistence of a significant degree of cellular dehydration may facilitate continued perfusion by providing accommodation space for accumulating interstitial water. To the extent the blood brain barrier is still intact the presence of escalating concentrations of hyperosmotic perfusate in the brain vasculature may provide an added buffer against cerebral edema.
There is ample clinical and experimental evidence that currently used TBW solutions such as MHP-2 and mRPS-2 are not effective at inhibiting cerebral edema in TBW followed by prolonged cold ischemia. Non-ischemic rabbits subjected to TBW and hours of subsequent cold storage near 0 deg C demonstrate failed or inadequate cortical reperfusion. Human cryopatients subjected to TBW followed by prolonged cold storage (~24 hours) often present with concave aortas and a marked absence of the vascular fluid leaks during median sternotomy (prior to perfusion) that is usually observed in patients with short post-washout cold storage times, further suggests that fluid is translocating from the vascular to the cellular compartment. (Absent intravascular pressure it is hard to imagine a mechanism whereby this fluid would be accumulating interstitially).
A relative contraindication to TBW is a prolonged agonal period with documented peripheral hypoperfusion (global hypostasis with a cuff MAP of 50 mm Hg or less) which terminates with ~1 hour or more of fixed and unresponsive pupils (i.e. prior to cardiac arrest). The author's experience is limited to two cases, and he knows of no others, so this observation must be regarded as tentative.
Clearly, additional reseasrch may result in the development of better cold storage solutions or even TBW solutions that decrease the risk of cerebral edema during CPA perfusion. However, based on currently available technology and experience, the above contraindications seem justified." - Mike Darwin