Perfluorocarbon-based artificial oxygen carriers in perioperative and surgical care: a scoping review of basic and translational studies.

BACKGROUND

Perioperative hypoxia remains a common clinical complication. Allogeneic blood transfusion and conventional oxygen support are widely used but limited by blood shortage, supply constraints and ethical challenges. Perfluorocarbon-based oxygen carriers (PFCs) possess superior oxygen solubility and favorable physicochemical features, making promising candidate adjuncts to improve perioperative oxygenation, despite multiple unresolved translational drawbacks.

METHODS

This scoping review strictly followed the PRISMA-ScR standard. Six mainstream databases were systematically searched for English human and animal studies published from 2000 to 2025 focusing on perioperative and surgical applications of PFCs; eligible literature was screened and data extracted based on predefined criteria.

RESULTS

A total of 55 publications including 13 randomized controlled trials were enrolled. Preclinical and clinical data demonstrated PFC effectively improves tissue oxygenation and organ protection across hemorrhagic shock, brain injury and acute lung injury, with the most consistent therapeutic gains observed in organ preservation. PFC can reduce allogeneic transfusion requirements during major surgery and benefit cerebral ischemia management, while inflammatory side effects, thrombocytopenia and other adverse reactions have been repeatedly documented.

CONCLUSION

PFCs show encouraging tissue-protective effects particularly in organ preservation, yet its broad clinical translation is hindered by inherent limitations such as high oxygen dependence, CARPA, reticuloendothelial deposition and historical failure of classic formulations. Further optimized formulation design and large-scale clinical trials are mandatory to improve safety and realize targeted clinical application.