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Oxygen Carriers

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Damage Control Resuscitation

Abstract

In blood, the primary role of RBCs is to transport oxygen via highly regulated mechanisms involving hemoglobin (Hb). Hb is a tetrameric porphyrin protein comprising of two α- and two β-polypeptide chains, each containing an iron-containing heme group capable of binding one oxygen molecule. In military as well as civilian trauma, exsanguinating hemorrhage can lead to suboptimal tissue oxygenation and subsequent morbidity and mortality. In such cases, transfusion of whole blood or RBCs can significantly improve survival. However, blood products including RBCs have limited availability and portability and present additional challenges related to type matching, pathogenic contamination risks, and short shelf-life. These issues lead to substantial logistical barriers to their pre-hospital use in austere battlefield and remote civilian conditions. While robust efforts are underway to resolve these issues, recent research breakthroughs have led to bioinspired engineering of RBC surrogates, using various cross-linked, polymeric, and encapsulated forms of Hb. These “next-generation” Hb-based oxygen carriers (HBOCs) can potentially provide therapeutic oxygenation when whole blood or RBCs are not available. Several of these HBOCs have undergone rigorous pre-clinical and clinical evaluation, but have not yet received clinical approval in the USA for human use. This chapter will comprehensively review both historical and new HBOC designs, including current state-of-the-art and novel molecules in development, along with a critical discussion of successes and challenges in this field.

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Authors and Affiliations

  1. Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA

    Anirban Sen Gupta

  2. Departments of Pediatrics, Biochemistry and Bioengineering, University of Maryland School of Medicine, Baltimore, MD, USA

    Allan Doctor

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    Philip C. Spinella

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Sen Gupta, A., Doctor, A. (2020). Oxygen Carriers. In: Spinella, P. (eds) Damage Control Resuscitation. Springer, Cham. https://doi.org/10.1007/978-3-030-20820-2_11

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