Perfluorocarbons for Oxygen Transport: Current Status
Perfluorocarbons (PFCs) are NOT currently used in routine clinical practice for oxygen transport in blood, and no PFC-based blood substitutes have achieved widespread clinical approval or use as of the latest evidence. The development of these agents has remained largely experimental despite decades of research.
Historical Context and Clinical Reality
The most extensively studied PFC emulsion, Fluosol, was tested clinically in the 1980s-1990s but demonstrated significant limitations including a short half-life (13 hours), requirement for very high inspired oxygen concentrations to be effective, and adverse effects related to the emulsifying agents 1
Clinical trials with PFC emulsions have failed to demonstrate clear clinical benefit in patient outcomes, despite theoretical advantages in oxygen delivery 1
Perflubron emulsion (60% weight/volume) underwent Phase III studies for augmented acute normovolemic hemodilution around 2000, but did not achieve regulatory approval or clinical implementation 2
Current Research Applications (Not Clinical Use)
PFCs remain under investigation in experimental settings for:
Regenerative medicine and organ preservation, where they are being studied using modern pharmaceutical quality-by-design methodologies, but these remain in development phases 3
Microcirculatory oxygen delivery research in ischemic conditions (stroke, myocardial infarction, burns), where in vivo and in vitro studies show potential benefits through facilitated diffusion and improved microvascular blood flow 4
Tissue preservation strategies for extremity salvage and organ transplantation, though these applications remain experimental 3
Why PFCs Have Not Achieved Clinical Success
Limited oxygen-carrying capacity compared to red blood cells, requiring extremely high inspired oxygen concentrations (near 100%) to achieve meaningful oxygen delivery 1
Short intravascular half-life limiting clinical utility 1
Adverse effects primarily related to emulsifying agents needed to make PFCs miscible in blood 1
Lack of proven clinical benefit in randomized controlled trials despite physiological improvements in some parameters 1, 2
Critical Clinical Pitfall
Do not confuse experimental PFC research with clinically available products. When oxygen-carrying capacity is needed clinically, packed red blood cells remain the standard of care, with hemoglobin targets of 70-90 g/L in most acute settings 5. There is no approved PFC product available for routine clinical oxygen transport as of 2025.