Department of Medical Education, California University of Science & Medicine, School of Medicine, 217 E Club Center Dr Suite A, San Bernardino, CA, 92408, USA.
Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA.
Scand J Trauma Resusc Emerg Med. 2019 Apr 24;27(1):50. doi: 10.1186/s13049-019-0614-6.
Existing difficult airway prediction tools are not practical for emergency intubation and do not incorporate physiological data. The HEAVEN criteria (Hypoxaemia, Extremes of size, Anatomic challenges, Vomit/blood/fluid, Exsanguination, Neck mobility) may be more relevant for emergency rapid sequence intubation (RSI).
A retrospective analysis included air medical RSI patients. A checklist was used to assess HEAVEN criteria prior to RSI, and Cormack-Lehane (CL) laryngoscopic view was recorded for the first intubation attempt. The incidence of a difficult (CL III/IV) laryngoscopic view as well as failure to intubate on first attempt with and without oxygen desaturation were determined for each of the HEAVEN criteria and total number of HEAVEN criteria. In addition, the association between HEAVEN criteria and both laryngoscopic view and intubation performance were quantified using multivariate logistic regression for direct laryngoscopy (DL) and video laryngoscopy (VL) configured with a Macintosh #4 non-hyperangulated blade.
A total of 5137 RSI patients over 24 months were included. Overall intubation success was 97%. A CL III/IV laryngoscopic view was reported in 25% of DL attempts and 15% of VL attempts. Each of the HEAVEN criteria and total number of HEAVEN criteria were associated with both CL III/IV laryngoscopic view and failure to intubate on the first attempt with and without oxygen desaturation for both DL and VL. These associations persisted after adjustment for multiple co-variables including the other HEAVEN criteria.
The HEAVEN criteria may be useful to predict laryngoscopic view and intubation performance for DL and VL during emergency RSI.
现有的困难气道预测工具在紧急插管中不实用，也不包含生理数据。HEAVEN 标准（低氧血症、极端大小、解剖学挑战、呕吐/血液/液体、出血、颈部活动度）可能与紧急快速序贯插管（RSI）更相关。
回顾性分析包括空中医疗 RSI 患者。在进行 RSI 前使用检查表评估 HEAVEN 标准，记录第一次插管尝试时的 Cormack-Lehane（CL）喉镜视图。确定每个 HEAVEN 标准和总 HEAVEN 标准下困难（CL III/IV）喉镜视图的发生率以及首次尝试插管时是否在无氧气饱和度下降的情况下失败。此外，使用多元逻辑回归分析直接喉镜（DL）和配备 Macintosh #4 非超角刀片的视频喉镜（VL），定量评估 HEAVEN 标准与喉镜视图和插管性能之间的关系。
共纳入 24 个月内的 5137 例 RSI 患者。总体插管成功率为 97%。在 DL 尝试中，25%的患者出现 CL III/IV 喉镜视图，在 VL 尝试中，15%的患者出现 CL III/IV 喉镜视图。在 DL 和 VL 中，每个 HEAVEN 标准和总 HEAVEN 标准均与 CL III/IV 喉镜视图以及首次尝试插管时在有或无氧气饱和度下降的情况下失败相关。在调整包括其他 HEAVEN 标准在内的多个协变量后，这些关联仍然存在。
HEAVEN 标准可能有助于预测紧急 RSI 期间 DL 和 VL 的喉镜视图和插管性能。
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