In the clinical setting, artificial oxygen carriers are needed when a patient has a tissue oxygen deficiency which he/she cannot automatically compensate. There are two quite different situations where this might occur: i) Heavy blood loss (e.g. following an accident) and ii) insufficient perfusion (e.g. as a result of arteriosclerosis or myocardial infarction) or anaemia without blood loss. In the first instance, an iso-oncotic oxygen-transporting plasma expander is required, whereas in the second instance a (hypo-oncotic) so-called blood additive is needed. This 2nd type of situation also presents the greater range of very important indications. Experimental work has shown that, in comparison to erythrocytes, dissolved haemoglobin is able to release oxygen more rapidly (effective plasmatic transport) while at the same time also facilitating oxygen release from erythrocytes (mediator function). Blood additives occur naturally in lower forms of life (e.g. earthworm) where they can be found in the form of giant oxygen-carrying molecules. Using these natural forms as a basis, new oxygen-transporting blood additives were designed and developed (so-called haemoglobin hyperpolymers) which exhibit a strong oxygen affinity (half saturation partial pressure p50 = 16 mm Hg) and high co-operativity (n50 = 2.1). One product has, up to now, been produced aseptically on a small technical scale and consists of highly purified, polymerised and pegylated porcine haemoglobin which is free of monomers and oligomers (mean molecular weight approximately 800 kDa). It is sufficiently low in endotoxin (< 0.029 EU/ml) and blood plasma compatible and – at an effective concentration of 3 g/dl in blood plasma – causes only minor increases in oncotic pressure or viscosity. The product has a shelf life of up to 2 years and is administered as a carbonyl derivative. Its intravascular half-life in the conscious rat is 30 h. This product was found to prevent death in rats in wchich acute lung injury was induced using oleic acid. In human self-experiments this product was repeatedly administered: No effects on blood pressure and heart rate, no increase in blood transaminase concentration and no immunological reaction were seen; the latter was also true for selected sensitive mice. Furthermore, the blood additive is universally applicable as an oxygen transporter since, when mixed with a conventional plasma expander, it can also be used to treat an oxygen deficiency occurring together with blood loss.