Potential Value of Polynitroxylated PEGylated Hemoglobin (SanFlow) in Pre-Hospital Medicine in Austere Environments including Military Deployments, Disasters and Remote Emergencies

Advancements in hemorrhagic shock resuscitation are reviewed with an emphasis on requirements for pre-hospital medicine in austere environments, including forward military deployments. Studies on the use of artificial oxygen carriers and cell-free hemoglobin go back almost 90 years. Due to the characteristics of future warfare in remote environments, the U.S. military has developed a new paradigm of Prolonged Field Care which poses new challenges in the development of blood substitutes and resuscitation agents. The development of SanFlow, a third generation hemoglobin-based oxygen carrier, is described. We compare and contrast SanFlow with other agents, highlighting data on its efficacy in oxidative stress models of traumatic brain injury combined with hemorrhagic shock. SanFlow presents itself as an effective alternative to whole blood. As a low-volume, shelf-stable, colloid resuscitative fluid that provides oxygen-carrying capacity to organs, SanFlow is poised to be transformative for pre-hospital medicine.