After Death, Nevada Issues Cryotherapy Guidelines


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Chelsea Ake-Salvacion, who died of asphyxia while in a cryotherapy machine at a spa in Henderson, Nev., in an undated photograph.

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Chelsea Patricia Ake-Salvacion/Albert Ake, via Associated Press

LAS VEGAS — After the death of a spa employee, Nevada has created health guidelines for cryotherapy, a treatment that experts say has been growing in popularity but is largely unregulated and whose benefits are not proven.

The guidelines from the state health department recommend that the machines, which subject users to subzero temperatures, not be used by those younger than 18, under five feet tall or with certain health conditions, said Dr. Tracey Green, the state’s chief medical officer. The health conditions include a history of stroke, high blood pressure, seizures and infections, as well as pregnancy, a pacemaker or claustrophobia.

Users should have only one session per day for no more than three minutes and have their blood pressure taken before and after.

“When things are available to individuals that don’t have any medical basis, we try to assure that there are safe practices,” Dr. Green said. She likened the guidelines, which were announced Friday, to the generally accepted ones for sauna use.

“Anytime we feel there’s risk, these kinds of guidelines can be developed,” Dr. Green said.

Chelsea Ake-Salvacion, 24, accidentally died of asphyxia caused by low oxygen levels while in a cryotherapy machine at the Rejuvenice spa in Henderson, where she worked, the Clark County coroner’s office said. She was found dead on Oct. 20 after apparently using the treatment on herself the night before.

Her death drew scrutiny to the treatment that has been used worldwide but is not quite mainstream.

Cryotherapy supporters claim it can ease pain and inflammation, aid blood flow and weight loss, improve skin and even ward off aging and depression. The treatment has been popularized by celebrities and sports stars who use it in lieu of a traditional ice bath. It can involve two- to four-minute exposures in a chamber the size of a telephone booth to temperatures ranging from minus 166 to minus 319 degrees.

But the federal Food and Drug Administration has not approved the treatments for medical use. They have also not been embraced by the medical or scientific communities, which acknowledge that liquid nitrogen has long been used medically for things like wart removal but point to a lack of evidence that full-body exposure can benefit people physiologically.

Dr. Green said that children as young as 14 had been offered the service and that operator training from manufacturers varied. The state learned this by investigating from scratch, reviewing the machine brochures, visiting sites and consulting with a major distributor.

Dr. Green said coming up with the guidelines had not been easy given that none existed and little was known about the treatment. In fact, it took more than a week for state officials to decide how to deal with cryotherapy after the death, with the health department opting to expand what was a worker safety probe and assume responsibility for complaints.

The state said that it would work with businesses to carry out its “expected standards,” but that the guidelines did not amount to law. Still to be determined is how oversight measures will be carried out to ensure the guidelines will be followed. The health department has said it will work with other agencies that regulate and license such businesses, including the Nevada Occupational Safety and Health Administration.

“There’s not a penalty,” Dr. Green said. “It’s really about public safety.”

The new guidelines ask cryotherapy centers to have nitrogen monitors in the rooms and emergency kits and defibrillators on site. Centers should also provide signs and waivers that clearly state that the treatment cannot treat illnesses or be used for medical purposes and that outline the service’s procedures and risks.

“The facility should not promote outcomes of the procedure that have not been scientifically evaluated, as this is confusing and misleading to the client,” the guidelines state.

Signs must also meet worker safety standards to warn of the risks of handling nitrogen tanks and nitrogen exposure, which can cause severe burns, lightheadedness, fainting and asphyxiation. Employees should have proper training on how to operate the machine and identify issues, as well as on cardiopulmonary resuscitation.

For now, the health department does not plan to pursue further regulation and is not directly addressing the medical concerns about the treatment, though the Colorado Department of Regulatory Agencies has assigned cryotherapy to a medical category that requires doctor oversight. Other states, like California and Wyoming, have taken a hands-off approach to what they consider an alternative treatment.

“I haven’t seen any medical validation,” Dr. Green said. “Again, this isn’t something we’re just going to turn our backs on, but we really haven’t seen any support for it.”

Dr. Green said the health department’s move was ultimately about educating the public. She urged consumers to put their health first by consulting their doctors before subjecting themselves to the treatment.

“It’s really my medical decision that these are very important guidelines for people potentially putting themselves” at risk, she said.



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