These sources do not evaluate BHOC and do not prove the safety or efficacy of any oxygen carrier. Their value is different. Together, they show how clinicians and emergency systems define the function they need, decide when support is required and build the infrastructure to deliver it.

The common threadBlood is a system with several functions. Oxygen delivery is one of them. The clinical question is not only which product is available, but which function must be restored, how quickly and whether the system can deliver it to the patient.

Three evidence signals

  1. Children: timing and eligibility matter. A modified Delphi consensus on prehospital transfusion in children addresses severe or suspected bleeding together with additional clinical criteria. It helps define when early oxygen-carrying support may be considered before hospital arrival. It does not establish improved survival, evaluate BHOC or show that oxygen delivery is the only function of transfusion. Primary source ↗
  2. Trauma centres: access still depends on the institution. The AABB summary of a national JAMA Network Open cohort describes 71,997 trauma patients across 650 centres. Balanced transfusion or whole blood use increased from 12.4% in 2018 to 37.6% in 2024, while hospital adoption and patient access varied substantially. This is evidence about adoption and institutional variation. It is not proof that whole blood or BHOC improves outcomes. JAMA study ↗ · AABB summary ↗
  3. EMS programmes: availability requires a system. The EMS Blood Program Coordinator framework describes cold-chain validation, inventory rotation, traceability, training, documentation and quality control. It does not study BHOC. It shows, however, that any future oxygen-delivery option will need operational discipline, not only a promising molecule. DOI ↗ · PubMed ↗

What this means for oxygen-delivery research

The evidence does not support a simple “blood versus BHOC” argument. Donor blood remains central when it is needed and available. The more precise question is whether the oxygen-delivery function can be supported during the period when compatible blood is delayed, unavailable or difficult to deploy.

That question should be tested with functional and clinical endpoints: perfusion, oxygen delivery, tissue oxygenation, patient physiology, time to support, safety and later outcomes. Haemoglobin concentration alone cannot answer the whole question.

BHOC boundaryBHOC is presented here as a research direction within Precision Oxygen Therapeutics, not as a proven clinical product. The sources above are external evidence and implementation signals. They do not establish BHOC efficacy, safety, approval or use in children, trauma or EMS.

Primary sources

  1. Magill C, Heintz H, Finney J, et al. Consensus Guidelines for Prehospital Transfusion in Children: A Modified Delphi Study. DOI ↗
  2. Acharya P, Griffin R, Jarman M, et al. Balanced Component and Whole-Blood Transfusion Practices in US Trauma Centers. JAMA DOI ↗
  3. O’Byrne H, Krohmer J, Schaefer R, et al. Prehospital Blood Transfusion Coalition: Framework for EMS Blood Program Coordinator Responsibilities. DOI ↗ · PubMed ↗
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