Ozone Improves Oxygenation and Offers Organ Protection after Autologous Blood Transfusion in a Simulated Carbon Dioxide Pneumoperitoneal Environment in a Rabbit Hemorrhagic Shock Model

Objectives: Autologous blood transfusion techniques are well applied in surgery, but the red blood cells (RBCs) collected during laparoscopic surgery may forfeit their ability to oxygenate. O₃ is a potent oxidation gas. This study investigates whether O₃ could improve the oxygen-carrying capacity of RBCs, reduce inflammatory reactions, and offer organ protection. Methods: We established a hemorrhagic shock model in rabbits, and simulated CO₂ pneumoperitoneum and O₃ were applied before autologous blood transfusion. Perioperative mean arterial pressure and arterial blood gas were recorded, blood gas and RBC morphology of collected blood were analyzed, plasma IL-6, ALT, AST, CRE, and lung histopathology POD0 and POD3 were tested, as well as postoperative survival quality. Results: Autologous blood that underwent simulated CO₂ pneumoperitoneum had a lower pH and SaO₂ and a higher PaCO₂ than the control group. After O₃ treatment, PaO₂ and SaO₂ increased significantly, with unchanged pH values and PaCO₂. RBCs in autologous blood were drastically deformed after CO₂ conditioning and then reversed to normal by O₃ treatment. Rabbits that received CO₂-conditioned autologous blood had a compromised survival quality after surgery, higher plasma IL-6 levels, higher lung injury scores on POD0, higher ALT and AST levels on POD3, and O₃ treatment alleviated these adverse outcomes. Conclusion: O₃ can restore RBC function, significantly improve blood oxygenation under simulated CO₂ pneumoperitoneum, offer organ protection, and improve the postoperative survival quality in the rabbit hemorrhage shock model.