Use of perflubron emulsion to decrease allogeneic blood transfusion in high-blood-loss non-cardiac surgery: results of a European phase 3 study.

The authors should be commended for carrying out an elaborate multicenter study in such an elegant fashion. The Methods are well described, the statistics appropriate and the Results are presented according to the highest standards for a randomized controlled trial (intent-to-treat, post-hoc analyses, etc.). The study highlights the following points: augmented ANH will only be beneficial in patients who sustain important blood losses (10 mL/kg or more) and the technique carries its share of difficulties. Inexperience with profound ANH may have been responsible for a number of adverse events experienced in the PFC group. However, when physicians become more familiar with profound ANH, learn to manage it well and apply it to the appropriate patients, oxygen-carrier augmented ANH should reduce transfusions without increasing morbidity/mortality.

– Jean-Franois Hardy

This prospective randomized study demonstrates the efficacy of a perfluorocarbon-based oxygen carrier to reduce exposure to allogeneic blood components when combined to acute normovolemic hemodilution in patients undergoing major surgery associated with high blood loss. This study also highlights the fact that the successful use of these products will require education of healthcare professionals to familiarize them with new concepts and physiology.

– Philippe Van der Linden