Use of HEAVEN criteria for predicting difficult intubation in the emergency department

Tan, Nin Ern and Yoong, Khadijah Poh Yuen and Yahya, Hj. Mohammad Fadhly (2022) Use of HEAVEN criteria for predicting difficult intubation in the emergency department. Clinical and Experimental Emergency Medicine, 9 (1). 29 -35. ISSN 2383-4625, DOI

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Objective Most airway prediction tools only consider anatomical factors. The HEAVEN criteria incorporate both anatomical and physiological elements, but have never been studied in the emergency department. This study aimed to evaluate the association between HEAVEN criteria and intubation difficulty. Methods We conducted a prospective cross-sectional study from April 1, 2020 to January 31, 2021 in the emergency department of a tertiary public hospital. All patients requiring rapid-se-quence or delayed-sequence intubation were included. Patients intubated during cardiopulmo-nary resuscitation were excluded. We enrolled 174 patients. Study endpoints were first pass success and intubation complications. Results The presence of any HEAVEN criteria was associated with a decrease in the first pass success rate (odds ratio OR, 0.10; 95% confidence interval CI, 0.02–0.43; P<0.01). The anatomical challenge was the only criterion associated with first pass sucess (OR, 0.13; 95% CI, 0.05– 0.29; P<0.01), whilst other criteria (hypoxemia, extremes of size, vomit/blood/fluid, exsanguina-tion, and neck mobility) were not (P>0.05). All anatomical factor criteria were associated with difficult airway view (P<0.05). Intubation complications occurred more in the presence of hy-poxemia (OR, 7.44; 95% CI, 2.82–19.63; P<0.01) and vomit/blood/fluid (OR, 5.55; 95% CI, 2.39–12.92; P<0.01). Conclusion Anatomical challenge in HEAVEN criteria can predict first pass success. All anatomical factors in HEAVEN criteria could predict difficult airway view and peri-intubation hypoxemia could be used to anticipate intubation complications. More validation studies are still needed to evaluate the use of HEAVEN criteria as a predictor tool for difficult airway. © 2022 The Korean Society of Emergency Medicine.

Item Type: Article
Funders: None
Uncontrolled Keywords: Adult; Article; Aspiration; Cohort analysis; Controlled study; Cross-sectional study; Difficult airway management; Difficult intubation; Emergency ward; Endotracheal intubation; Exsanguination; Female; Heart arrest; Heart arrhythmia
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Medicine
Depositing User: Ms. Juhaida Abd Rahim
Date Deposited: 17 Nov 2023 02:36
Last Modified: 17 Nov 2023 02:36

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