Oxygen therapeutics in trauma and surgery

A number of oxygen therapeutics have completed safety trials and are now undergoing efficacy evaluation in multicenter phase III trials in North America and Europe. There are numerous potential advantages of these solutions when compared with packed red blood cells. They are readily available and have a long shelf life; do not require type and cross-matching; are virtually free of viral or bacterial contamination; have a much lower viscosity than blood; and may lack the immunosuppressive effects of blood. These products may also deliver more oxygen per unit mass than an equivalent amount of hemoglobin from red blood cells, providing the potential to sustain life in certain clinical situations. A few problems remain, including short biologic half-life, which may limit the application to times when the patient is most acutely anemic (i.e., in the intraoperative or immediate perioperative phase) or for emergent use. Nevertheless, a safe, effective alternative therapy providing oxygen delivery characteristics comparable to red blood cells may soon be available that could have significant impact on the way that we resuscitate trauma patients.