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The basic properties of perfluorocarbons (PFCs) and PFC emulsions relevant to their use as oxygen delivery systems are briefly reviewed. The key issues related to the selection of an appropriate, readily excretable PFC and the engineering of a stable injectable PFC emulsion are discussed. OxygentTM, a terminally heat-sterilized, injectable 60% w/v PFC emulsion made primarily of F-octyl bromide and a few percent of F-decyl bromide, with egg phospholipids as an emulsifier, has been developed. Its efficacy in avoiding and reducing red cell transfusion during surgery has been established during a Phase III clinical evaluation. Another Phase III clinical trial in cardiopulmonary bypass surgery, with a protocol that included both augmented-acute normovolemic hemodilution and intraoperative autologous donation, has, however, been interrupted following the observation of adverse events. Data analysis assigned these events to an inappropriate study protocol. A search for possible interactions between Oxygent and fluids present during cardiopulmonary bypass surgery detected no effect of the emulsion on hemostasis, hemolysis and blood rheology. [ABSTRACT FROM AUTHOR]

The unique behavior of perfluorocarbons (PFCs), including their high oxygen dissolving capacity, hydrophobic and lipophobic character, and extreme inertness, derive directly, in a predictable manner, from the electronic structure and spatial requirements of the fluorine atom. Their low water solubility is key to the prolonged in vivo persistence of the now commercially available injectable microbubbles that serve as contrast agents for diagnostic ultrasound imaging. Oxygen TM, a stable, small-sized emulsion of a slightly lipophilic, rapidly excreted PFC, perfluorooctyl bromide (perfiubron), has been engineered. Significant oxygen delivery has been established in animal models and through Phase II and III human clinical trials. However, an inappropriate testing protocol and the lack of funding led to temporary suspension of the trials. [ABSTRACT FROM AUTHOR]

An oxygen carrying, heat-sterilized phospholipid-based emulsion of a fast excreted lipophilic fluorocarbon, perfluorooctyl bromide (perflubron), stabilized against molecular diffusion, has been developed to serve as a temporary blood substitute. It is expected to reduce exposure to donor blood and thereby help mitigate the pressure on our blood supply. A phase III clinical trial in Europe has demonstrated that use of the emulsion resulted in avoidance and reduction of donor blood transfusion in surgery patients. Further potential applications for fluorocarbon emulsions include use as a bridge to transfusion, treatment of myocardial ischemia and stroke, potentiation of radio and chemotherapy and preservation of organs destined for transplantation. Echogenic, injectable gaseous microbubbles, osmotically stabilized by perfluorohexane, provide an effective contrast agent for ultrasound imaging. Clinical trials have established improved imaging of the walls of the heart and, hence, assessment of cardiac function. The ability of improving detection of myocardial perfusion, blood flow abnormalities and solid tumors is also being investigated. Various families of fluorinated amphiphiles with modular molecular structures and polar heads derived from natural products have been synthesized. Due to their highly hydrophobic perfluoroalkylated tail chains, these amphiphiles readily self-assemble into stable fluorinated vesicles, tubules and other organized molecular systems with distinctive properties. Fluorosurfactants also allowed preparation of direct, reverse, apolar and multiple emulsions and gels. These fluorinated colloids have potential for the delivery of drugs and other bioactive materials, and provide unique tools in biomedical research. [Copyright &y& Elsevier]

Summarizes some studies on the development of injectable oxygen delivery systems for blood transfusions. Challenges facing transfusion medicine; Change in the paradigm of oxygen delivery; Characteristics of various oxygen carriers.