Continuous heliox breathing and the extent of anatomic zone of noreflow and necrosis following ischemia/reperfusion in the rabbit heart.

BACKGROUND: Nitrogen may contribute to reperfusion injury. Some studies have shown that helium as a replacement for nitrogen in breathing gas (heliox) reduces cell necrosis after ischemia/reperfusion when used in a preconditioning fashion (intermittent heliox exposure). Our aim was to test whether heliox, breathed continuously throughout the ischemic and reperfusion periods, reduced necrosis and a marker of reperfusion injury, the no-reflow phenomenon. METHODS AND RESULTS: Anesthetized, open-chest rabbits received 30 min coronary artery occlusion/3 hrs reperfusion. Before CAO rabbits were randomized to heliox (30% oxygen + 70% helium, n=8) or air supplemented with oxygen to achieve blood gas values within physiologic range (n = 8). Rabbits received the appropriate mix during ischemic and reperfusion periods. Infarct size (% risk zone) and no-reflow defect were measured at the end of the reperfusion period. The ischemic risk zone was similar in both groups (28% of left ventricle in heliox and 29% in control). Heliox breathing did not reduce necrosis; infarct size, expressed as a percentage of the risk region was 44±4% in the heliox group and 49±5% in controls, p = 0.68. The extent of the no-reflow defect was not altered by heliox, either expressed as a percent of the risk region (29±4% in heliox and 28±3% in control) or as a percent of the necrotic zone (65±5% in heliox and 59±8% in control).Heliox treatment had no effect on hemodynamic parameters or arterial blood gas values. CONCLUSION: Continuous heliox breathing does not appear to be cardioprotective in the setting of acute myocardial infarction in the rabbit model. Heliox respiration administered during 30 minutes of ischemia and 180 minutes of reperfusion did not alter infarct size or the extent of no-reflow.

Heliox and oxygen reduce infarct volume in a rat model of focal ischemia.

Normobaric hyperoxia treatment has recently been demonstrated to be remarkably beneficial in acute focal ischemia. The present study compared hyperoxia treatment with a novel heliox treatment. Adult male rats breathed 30% oxygen and 70% nitrogen (control group), 100% oxygen (hyperoxia group), or 30% oxygen and 70% helium (heliox group) during a middle cerebral artery occlusion for 2 h and a 1-hour reperfusion (n=6 in each group). Neurological deficits were scored at 3 and 24 h post focal ischemia. Neither the physiological parameters (body temperature, blood pressure, heart rate, O(2) saturation, and laser Doppler cerebral blood) nor the 3-hour post ischemia neurological scores differed between groups. However, the neurological scores showed a statistically significant improvement at 24 h post ischemia in the heliox group (p<0.05). The infarct volume (mean+SD) as measured by 2,3,5-triphenyltetrazolium staining included 36+/-17% of the involved hemisphere in the control group, 16+/-14% in the hyperoxia group, and 4+/-2% in the heliox group (p<0.01). In conclusion, whereas hyperoxia reduced the infarct volume, heliox further reduced the infarct volume and improved 24-hour neurological deficits in a rat model of focal ischemia. This suggests that a greater benefit may accrue from heliox therapy.

The swelling of mitochondria from nitrogen gas; a possible cause of reperfusion damage.

Electron photomicrograph evidence is presented which suggests that the in vivo swelling of mitochondria may result from the uptake of nitrogen gas bubbles which coalesce to fill the intramitochondrial space during tissue anoxia. These observations have led to the hypothesis that nitrogen-filled mitochondria are unable to take up oxygen resulting in cell death. A test of this hypothesis also represents a probable treatment for stroke, namely the total body washout of nitrogen. This can be achieved by the inhalation of an oxygen-helium mixture with exhaled gases shunted to ambient atmosphere. This washout should facilitate nitrogen egress from the interior of affected mitochondria, allow oxygen uptake and a resumption of oxidative metabolism. This hypothesis generally fits well with the literature on luxury perfusion following stroke. In cases of luxury perfusion the venous blood exiting the lesion is red indicating a decreased transfer of oxygen to the extracellular and cytosolic fluids. However, whereas luxury perfusion assumes blood flow adequate for delivery of oxygen to the tissues, this hypothesis interjects a blockade at the level of oxygen uptake into mitochondria, and unless this blockade is reversed it will lead to cell death and brain tissue necrosis in the affected regions.