HEAVEN Criteria: Prediction of Difficult Airway for In- Hospital Emergency Airway Management

Thomas Riva2,800 enrolled

Overview

The HEAVEN criteria were found valid to predict difficult airways during preclinical emergency intubations in a retrospective study. The acronym stands for Hypoxemia, Extremes of size, Anatomic abnormalities, Vomit/blood/fluid, Exsanguination/anaemia, and Neck mobility issues. This is a monocentric prospective observational study to assess the validity of the HEAVEN criteria in the in-hospital setting at a level I adult and pediatric emergency university-based hospital.

Emergency intubations are prone to present a difficult airway. A difficult airway can lead to prolonged intubation time and to hypoxemia in situations where oxygenation is not possible that can finally result in hypoxic cardiac arrest and irreversible brain damage caused by hypoxic ischemic encephalopathy. Tools to predict difficult airways are rather poor concerning specificity and sensitivity. A score to predict difficult airway developed in the pre-clinical setting are the HEAVEN criteria. The acronym HEAVEN stands for: Hypoxemia, Extremes of size, Anatomic abnormalities, Vomit/blood/fluid, Exsanguination/anaemia, and Neck mobility issues and does not need patients' cooperation. It has been recently validated in the pre-clinical emergency setting and was found to be useful. The study aim is to evaluate if the HEAVEN criteria are suitable to be used to predict difficult airway in in-hospital emergency intubation to finally increase patients' safety during rapid sequence induction (RSI). This prospective observational single-centre study in emergency intubation will consecutively recruit all patients of all ages who need RSI due to their medical condition performed by the staff of the Department of Anaesthesiology and Pain Medicine at the Bern University Hospital. We will record data that are gathered during routine patient care and stored primarily in the departmental anaesthesia information systems. The primary objective is to validate if the HEAVEN criteria, an existing prehospital difficult airway prediction tool, is able to predict airways difficulties during RSI in the clinical in-hospital setting. The secondary objective is, to assess the subcomponent of the HEAVEN criteria and if differences and adaptations are needed comparing it to the prehospital setting.

Study Type

OBSERVATIONAL

Enrollment

2,800

Conditions

Respiratory Failure

Interventions

Rapid sequence inductionPROCEDURE

Rapid sequence induction starts with the administration of rapid acting intravenous narcotics, opioids and neuromuscular blockage and avoids whenever possible positive-pressure ventilation after induction of anesthesia.

Eligibility

Sex: ALL

Medical Language ↔ Plain English

Inclusion Criteria: * All consecutive patients of all ages who need an in-hospital rapid sequence intubation (RSI) performed by the staff of the Department of Anesthesiology and Pain Medicine * Given general consent or delayed obtained general consent after the procedure * English, German or French speaking patients Exclusion Criteria: • Patients without informed consent

Locations (1)

University Hospital Bern

Bern, Canton of Bern, Switzerland

Outcomes

Primary Outcomes

Patients with first-attempt success rate of RSI

Every attempt starts with the insertion of a laryngoscope blade over the lips and ends with a blocked tube in the trachea and measuring of carbon dioxide (CO2)

Time frame: 1 hour

Patients with difficulty of intubation

Rated on a scale by the airway manager: easy, difficult, not possible

Time frame: 1 hour

Secondary Outcomes

Overall success rate of rapid sequence induction (RSI)

All RSI during the study period are analyzed for success (If intubation is possible or not)

Time frame: 1 hour

Patients with first-attempt success without desaturation SpO2 <92% during RSI

Saturation will be measured and recorded during the whole intervention and analyzed for the time of the RSI.

Time frame: 1 hour

Total attempts of intubation in a patient

Every attempt starts with the insertion of a laryngoscope blade over the lips and ends with a blocked tube in the trachea and measuring of CO2

Time frame: 1 hour

Cormack & Lehane grade (C&L) or Percentage of Glottis Opening (POGO) in a patient

C\&L for direct laryngoscopy or POGO for video laryngoscopy will be recorded for every intubation

Time frame: 1 hour

Lowest and highest recorded value of patients' heart rate (HR) during RSI

Heart rate will be measured and recorded during the whole intervention and analyzed for the time of the RSI.

Data from ClinicalTrials.gov

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