Perflubron emulsion delays blood transfusions in orthopedic surgery. European Perflubron Emulsion Study Group.
BACKGROUND
Fluorocarbon emulsions have been proposed as temporary artificial oxygen carriers. The aim of the present study is to compare the effectiveness of perflubron emulsion with the effectiveness of autologous blood or colloid infusion for reversal of physiologic transfusion triggers.


METHODS
A multinational, multicenter, randomized, controlled, single-blind, parallel group study was performed in 147 orthopedic patients. Patients underwent acute normovolemic hemodilution with colloid to a target hemoglobin of 9 g/dl with an inspiratory oxygen fraction (FIO2) of 0.40. Patients were then randomized into one of four treatment groups after having reached any of the protocol-defined transfusion triggers including tachycardia (heart rate > 125% of posthemodilution rate or > 110 bpm), hypotension (mean arterial pressure < 75% of posthemodilution level or < or = 60 mmHg), elevated cardiac output (> 150% of posthemodilution level) or decreased mixed venous oxygen partial pressure (PVO2; < 38 mmHg). Treatments in the four groups were 450 ml autologous blood harvested during acute normovolemic hemodilution given at FO2 = 0.40; 450 ml colloid at FIO2 = 1.0; 0.9 g/kg perflubron emulsion with colloid (total = 450 ml) at FIO2 = 1.0; and 1.8 g/kg perflubron emulsion with colloid (total = 450 ml) at FIO2 = 1.0. The primary endpoint was duration of transfusion-trigger reversal. A secondary end-point was percentage of transfusion-trigger reversal.


RESULTS
Perflubron emulsion was well tolerated with no serious adverse event attributed to drug treatment. Duration of reversal was longest in the 1.8 g/kg perflubron group (median, 80 min; 95% confidence interval, 60-100 min; P = 0.014 vs. autologous blood, P < 0.001 vs. colloid) followed by the 0.9 g/kg perflubron group (median, 59 min; 95% confidence interval, 40-90 min), the autologous blood group (median, 55 min; 95% confidence interval, 30-70 min) and the colloid group (median, 30 min; 95% confidence interval, 27-60 min). Percentage of reversal was also highest in the 1.8 g/kg perflubron group (97%; P < 0.001 vs. autologous blood; P = 0.014 vs. colloid), followed by 0.9 g/kg perflubron (82%), colloid (76%), and autologous blood (60%).


CONCLUSIONS
Perflubron emulsion (1.8 g/kg) combined with 100% oxygen ventilation is more effective than autologous blood or colloid infusion in reversing physiologic transfusion triggers.
Spahn
D R
DR
Department of Anesthesiology, University Hospital Zürich, Switzerland. donat.spahn@ifa.usz.ch
van Brempt
R
R
Theilmeier
G
G
Reibold
J P
JP
Welte
M
M
Heinzerling
H
H
Birck
K M
KM
Keipert
P E
PE
Messmer
K
K
Heinzerling
H
H
Birck
K M
KM
Keipert
P E
PE
Messmer
K
K
D000368:Aged; D000465:Algorithms; D016063:Blood Loss, Surgical; D001802:Blood Substitutes / Q000009:adverse effects / Q000627:therapeutic use*; D001804:Blood Transfusion, Autologous; D003102:Colloids; D004655:Emulsions; D005260:Female; D005466:Fluorocarbons / Q000009:adverse effects / Q000627:therapeutic use*; D006438:Hemodilution; D006801:Humans; D006842:Hydrocarbons, Brominated; D020896:Hypovolemia / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D010976:Platelet Count; D016037:Single-Blind Method
D001802:Blood Substitutes; D003102:Colloids; D004655:Emulsions; D005466:Fluorocarbons; D006842:Hydrocarbons, Brominated; C003072:perflubron