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Re: The Cost of Competent Care Providers

November 15 2009 at 4:15 AM
Steve Harris  (Login StevenHarris)
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Response to The Cost of Competent Care Providers

 
Maxim:
The same tack should be taken, in regard to someone to femoral cannulations. SA should bring a licensed embalmer, (or some other person capable of competently performing femoral cannulations), on staff and research the related issues, of working in other states. Embalmers earn about half as much as the average RUP, and work twice as hard, so if SA is having trouble doing that, I must believe it is simply poor management and a total lack of recruiting skills. The description of Baldwin's cannulation attempts, in the SA case report for CI-95 read like a recitation of a textbook-like description of a procedure she very-obviously was not capable of performing. (More about that, on my blog, soon.)

COMMENT:

Can't wait to see it. Do post synopsis here.

Since some of the failure of CI-95's washout (which was, in the end, unsatisfactory) was due to the mortician on the scene, who did no better than Catherine had (I'll let you figure out why, from the report; some of it is more obvious than other parts, but far be it from me to spoil your fun).

So far as I can tell, no mortuarial person (from lofty funeral director to lowly embalmer) has yet succeeded in placing a venous cannula in a cryonics patient suitable for full body washout.

Why this should be, is not hard to figure out. Embalmers aren't trained to do anything like cryonics. Even dedicated licenced embalmers, who get the most practice embalming, aren't doing CPB. Even in a good split embalming, the emblamer has more or less succeeded when embalming fluid has gone through most capillary beds, and has reached and flushed out the venous system. Until this time, venous cannulae in embalming aren't even kept open. When they are opened, it's to remove clots or releave momentary pressure. Normal embalming venous cannulae are thus short, and rigged to remove clots, not reach the central point of the circulation so as to releave venous pressure using gravity drainage suction (as must happen in CPB).

The embalmer doesn't care about venous pressure in the same way a cryonicist does, and doesn't even care much about arterial pressure. Most embalming fluid which goes into the arterial system does NOT appear in the venous system. The difference, which in medicine would be a sort of tissue edema, is looked upon with favor by the embalmer, since the plumping usually improves appearance, and tissue retension of fluid is certainly necessary for fixation. The embalmer uses perhaps 15% of the body weight in fluid. In cryonics we use 25 to 50% of body weight in washout solution, and if you count closed circuit perfusion, far more goes into the arteries than that (something approaching body weight). If you tried that with emblaming fluid you would soon reach pressure you could not support at even fractional flows, and your venous drainage would fall toward zero. Which is why it isn't done, and why no embalmer worries about setting up venous drainage that would allow for it. Embalming quits just as medicine and cryonics are getting started, as about twice the circulatory volume of fluid has been injected, and perhaps most of the venous volume of blood has been returned. That part's easy-- it's going on from there, that is hard. At least it's hard if you care about blowing the lungs and causing gross edema.

Let me put it another way: embalmers simply never run as much fluid through a body as do cryonicists (or for that matter, perfusionists). And since they don't, they don't know HOW to. And the solution to this is not simply to hire perfusionists, because perfusionists aren't skilled at placing venous drains either. Perfusionists (or somebody doing their job) are necessary, but not sufficient.

Embalmers who are skilled at central drainage may be of some help to cryonicists, when it comes to slow cryoprotectant perfusion, at the very end of the cryonics process. CI employs them this way. Indeed Alcor doesn't need a perfusionist at this point, once access has been attained. But this sort of thing is of no help in the field, or for rapid washout or rapid cooling. Cryonics-wise, as an aim to advance the science of cooling, it's a dead end.

What's the use of pigs? Not only for practice in perfusion! They're also for practice in access. Are they perfect as a cryonics model? No. It turns out nothing is, but fresh human cadavers. However, we do what we can. Dog arteries and veins are easier than human ones, but again, they're still good training.

A cryonics washout for cooling purposes, done in the field (as opposed to the central cryonics institution) on a human being warm enough to benefit from it, has (as I said) to my knowledge never been done successfully by a mortician or embalmer. It has actually, for reasons related to speed and the difficulty of standby, been done very few times, even by cryonicists. Mike Darwin did it a few times. I personally have probably done it more than anybody. Other than Mike and myself, I can't think of anybody else who has.

Anybody reading this who has a case to jog my memory, or that I don't know about, feel free to chime in.

Meanwhile, feel free to profit from the experience of the person who has the most experience at field perfusion in cryonics, which I guess would be me. It would be a first if you did, but one can always hope.

Steve Harris


    
This message has been edited by StevenHarris on Nov 15, 2009 4:17 AM


 
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