Part 1: Procedures

The operating room at Alcor’s Scottsdale, Arizona, facility.

The operating room becomes very busy during a cryonics case. As many as a dozen technicians and support staff can be required. Procedures are performed by physician or veterinary surgeons with extensive cryonics experience, and technicians with knowledge of the process of cryoprotectant perfusion.

Contract surgeons work to gain access to major blood vessels. At this point, the patient is typically at a temperature of 60°F or lower. This permits blood circulation to be stopped for a limited time without harming the brain. Sterile technique is utilized.

Once vascular access is established, the patient will be connected to a perfusion machine that replaces blood with a chemical solution that prevents ice formation.

A technician prepares the cryoprotectant solution perfusion circuit. The wires behind the plastic tubing are used for electronic monitoring and data collection.

A bank of heart-lung machine roller pumps (below) circulate cryoprotectant solution into the patient in gradually increasing concentration. A computer system (above) monitors and collects temperature, pressure, and cryoprotectant concentration data during this four hour procedure.

A technician checks lines connected to electronic devices that measure cryoprotectant concentration (refractometers).

A final manual check of the refractive index of the cryoprotectant solution verifies that the concentration is sufficient for vitrification (deep cooling without freezing).

The patient is now transferred from the operating room to the cooldown facility, where cooling to -130°C takes place under computer control. The result of this process is “vitrification” (solidification without freezing).

Following vitrification, neuropatients are placed in individual aluminum containers.

Containers are finally immersed in liquid nitrogen at a temperature of -196°C for long-term care.

Part 2: Field Equipment

THOMAS PACK: Alcor’s standby/ transport teams are equipped with medications for immediate use on patients after cardiac arrest. These meds serve several purposes, including prevention of blood clots and inhibition of ischemic injury (the cellular damage which occurs during absent or inadequate blood circulation). Team members transport a full range of medications in a padded backpack of a type that is standard issue for paramedics nationwide.

PACK MODULES: The backpack opens to reveal padded, color-coded modules which can be removed rapidly in an emergency.

ANCILLARY SUPPLIES: The backpack also has side compartments for medical equipment such as nitrile gloves and face masks. A separate insulated meds pack (the yellow module in the background) fits in the center of the backpack.

INJECTABLE MEDICATIONS: The yellow insulated meds module opens to reveal injectable medications which are kept refrigerated prior to deployment.

HEPARIN: While some of Alcor’s transport medications were specially formulated to inhibit ischemic injury, other meds are standard pharmaceutical items. First and most important is heparin, a powerful anticoagulant. Preventing blood clots is a vital first step, since the circulatory system must remain unobstructed for additional medications and subsequent cryoprotective perfusion.

LUCAS: In 2002 Alcor acquired this state-of-the-art LUCAS cardiopulmonary support device direct from its manufacturer in Sweden. It is shown here with a resuscitation-practice manikin in a portable ice bath. The LUCAS can be powered by compressed air, oxygen, nitrogen, or carbon dioxide gas. It applies chest compressions to circulate the blood and maintain respiration.

CARDIOPUMP: If circumstances prevent us from using the LUCAS, an Ambu CardioPump is a handheld backup device. The CardioPump is widely used in Europe but has not received FDA certification in the United States, even though its suction cup greatly increases the effectiveness of traditional CPR by enabling the user to pull up as well as push down. Fortunately, regulations permit Alcor to apply the imported CardioPump to patients after legal death has been pronounced.

PULSE OXIMETER: A pulse oximeter of this type fits over the patient’s finger and indicates pulse rate and oxygen saturation of the blood. While Alcor cannot and does not intervene medically with living patients, in situations such as a home hospice we may offer patients the option of using a pulse oximeter themselves, since it does not pierce or break the skin and requires virtually no training. A steady decline in oxygen saturation often provides advance warning of cardiac arrest. After cardiac arrest, a pulse oximeter measures the effectiveness of cardiopulmonary support by continuing to measure blood oxygen levels. During good mechanical CPR, a pulse oximeter will actually acquire a pulse (concurrent with mechanical strokes) even though the heart remains stopped.

AIR-TRANSPORTABLE PERFUSION KIT (ATP): The Air-Transportable Perfusion kit (ATP) contains a pump and heat exchanger which can be deployed in the field to wash out the patient’s circulatory system, substituting blood with a transport solution which cools the patient internally and provides metabolic support during transport to Alcor’s facility. The transport solution, developed in the 1980s, was tested and proven in groundbreaking research involving the resuscitation of animals after more than four hours of bloodless hypothermia. Alcor helped to sponsor this research effort, which was led by Jerry Leaf and Michael Darwin of Cryovita Laboratories. The ATP case opens to reveal the pump (cylindrical object at right) and its electronic speed controller (gray box at left). In the lid of the case is a blue sterile pack containing tubing, heat exchanger, filter, and other components.

ATP: When the sterile pack is opened, it reveals a metal baseplate on which the components are mounted. A second sterile pack (blue paper package at right) contains the manifold-the tubing which is connected to the patient after a femoral cutdown and cannulation. The baseplate fits back into the lid of the ATP case. The controller is deployed wherever convenient. A separate plastic reservoir (not shown here) is used to contain ice and a submersible pump. This pump circulates icewater through the heat exchanger, which extracts heat from the perfusate before it passes through the patient.

ATP: The transport solution is air-shipped in a smaller, separate case (shown at left of photo) which contains a 20-liter plastic bladder. Using sterile technique, this is attached to the ATP immediately prior to use.

TUBING: When the manifold is unwrapped it reveals color-coded tubing to which manometers (pressure gauges) and temperature sensors can be connected. A battery-powered, handheld “DuaLogR” records temperatures automatically at preprogrammed intervals, and travels with the patient to Alcor’s operating room.

TRANSPORT CASES: The complete remote standby and transport kit is packed into six large, rugged cases which can be checked as baggage on regular scheduled airlines.

Part 3: Facility Equipment

MOBILE ADVANCED RESCUE CART (MARC): Alcor’s Mobile Advanced Rescue Cart (MARC) is deployed via our ambulance for use in local cases. The cart was custom-fabricated from welded steel. A cardiopulmonary support device, such as the LUCAS, is placed over the patient in an ice bath and driven by two compressed-gas cylinders in the base of the cart. The cart also incorporates a blood pump/oxygenator system for heart-lung bypass (when surgically possible). The MARC enables uninterrupted blood circulation and rapid surface cooling while the patient is being transported to our facility.

MARC: The ice bath on the MARC contains a submersible pump which is powered by batteries below. The two flexible blue tubes are placed over a patient lying in the bath, and are perforated to distribute icewater as effectively as possible across the skin.

PERFUSION EQUIPMENT: In Alcor’s operating room, this array of equipment controls and monitors the process of cryoprotective perfusion. Four medical-grade roller pumps in the base of the array allow precise control of pressure and flow. Four refractometers (small, square units in the center) monitor changes in cryoprotectant concentration. A computer displays and records temperature, pressure, and concentration data. Tubing, filters, a heat exchanger, and liquid reservoirs would be added during an actual case.

PERFORATOR: Numerous medical instruments are used during surgical preparation of cryonics patients. One of the instruments is a standard neurosurgical tool called a perforator. It is specially designed to penetrate the skull without harming the brain. The perforator is used during cryonics surgery to make two small holes (one over each brain hemisphere) so that the surface of the brain can be observed during cryoprotective perfusion. If the wall of small brain blood vessels (blood brain barrier) becomes damaged by long intervals of stopped blood circulation (ischemia), brain swelling (edema) can occur during perfusion. Since edema is potentially destructive, it must be carefully monitored.

SUPERCOOL X-1000 ICE BLOCKER: Alcor’s cryoprotectant solutions incorporate state-of-the-art “ice blockers” to prevent ice formation during vitrification. These ice blockers have been shown in published studies to permit vitrification of larger volumes at slower cooling rates than previously possible.

COOLDOWN AREA: In the foreground at right, the whole body cooling bath is a large rectangular box whose thick walls contain three layers of Dow Trymer foam insulation. The purpose of this equipment is to reduce the temperature of a wholebody patient after cryoprotective perfusion, by immersing the patient in silicone oil cooled with dry ice. Two drums of oil are visible at the bottom of this photo. After the bath has been partially filled, a patient is wrapped in protective plastic and strapped to the wire-mesh stretcher, which is lowered into the oil. An insulated lid is placed over the bath, and a pump circulates the oil through a trough containing large pieces of dry ice (frozen carbon dioxide) whose temperature is -79° Celsius. A newer system (not shown) is able to cool wholebody patients using cold nitrogen vapor to even lower temperatures for purposes of achieving vitrification. Wholebody vitrification technology is still under development.

Behind the whole-body bath is the neuro cooldown area, where nitrogen vapor is injected through a computer-controlled valve into a small Dewar containing a neuropatient. In the background stands a tall Dewar which is used to slowly cool a wholebody patient from -79° to -196° (the temperature of liquid nitrogen).

NEURO COOLDOWN EQUIPMENT: A Dewar of liquid nitrogen (foreground) is connected to a small neuropatient cooldown Dewar (background). A computer control system maintains a pre-programmed temperature descent by periodically injecting liquid nitrogen into the Dewar while a fan continuous stirs the nitrogen gas. The computer also receives data from temperature sensors in the patient.

BIGFOOT DEWAR: Bigfoot Dewars are Alcor’s primary patient care system. Dewars are stainless steel vacuum-insulated containers that hold liquid nitrogen (named after their inventor, Sir James Dewar, in 1885). Alcor’s Dewars are called “Bigfoot” because of the large casters at the bottom. Each Bigfoot can hold four wholebody patients, or 10 neuropatients in each space that would otherwise be occuppied by a whole body patient. Patients are maintained at a steady temperature of -196° Celsius, immersed under liquid nitrogen, with no need for electricity. Approximately 15 liters of liquid nitrogen per day evaporates from a Bigfoot Dewar, which must be periodically replenished.