Clinical Research

First pass success is important in prehospital tracheal intubation to minimize the risk of physiologic deterioration.


D.Olvera – A.Patanwala – A. Wolfe Jr. – J. Sakles Abstract Pre-hospital tracheal intubation of the critically ill and injured can be challenging and patients are at risk of serious complications. The purpose of this study was to determine the association between the number of intubation attempts and the occurrence of physiologic deterioration. This institutional […]

The Use of Ketamine for Air Medical Rapid Sequence Intubation Was Not Associated With a Decrease in Hypotension or Cardiopulmonary Arrest


Rapid sequence intubation (RSI) is associated with a number of complications that can increase morbidity and mortality. Among RSI agents used to blunt awareness of the procedure and produce amnesia, keta-mine is unique in its classification as a dissociative agent rather than a central nervous system depressant. Thus, ketamine should have a lower risk of peri-RSI hypotension because of the minimal sympatholysis com-pared with other agents.

Prehospital Blood Glucose Testing as a Predictor of Impending Hypotension in Adult Trauma Patients


Joseph Hill RN, BSN, CMTE, CFRN1 David M. Gothard MS2 Michelle M. McLean MD, EMT-P, CHSE3 1Air Methods Corporation, Greenwood Village, CO 2Biostats, North East Canton, OH 3LifeNet of Michigan, Greenwood Village, CO Abstract Objective: Stress-induced hyperglycemia has been found to increase hemorrhagic shock, morbidity, and mortality in the trauma patient. The purpose of this study is to […]

The HEAVEN Criteria Predict Laryngoscopic View and Intubation Success for Both Direct and Video Laryngoscopy: A Cohort Analysis


Fauzia Nausheen1, Nichole P. Niknafs2, Derek J. MacLean2, David J. Olvera, Allen C. Wolfe Jr, Troy W. Pennington2,3 and Daniel P. Davis1,2,3 1Department of Medical Education, California University of Science & Medicine, School of Medicine, 217 E Club Center Dr Suite A, San Bernardino, CA 92408, USA. 2Department of Emergency Medicine, Arrowhead Regional Medical Center, […]

Clinical operations in the back of helicopter.

Vital Sign Patterns Before Shock-Related Cardiopulmonary Arrest


Traditional vital sign thresholds reflect an increased risk of mortality, which may occur hours, days, or weeks following illness/injury, limiting immediate clinical significance to guide rescue therapy to avoid arrest. Our objective is to explore vital sign patterns prior to arrest due to shock.

Clinical Education Training

A Continuous Quality Improvement Airway Program Results In Sustained Increases In Intubation Success


Airway management is a critical skill for air medical providers, including the use of rapid sequence intubation (RSI) medications. Mediocre success rates and a high incidence of complications has challenged air medical providers to improve training and performance improvement efforts to improve clinical performance.

Systolic Blood Pressure Threshold for HEMS-Witnessed Arrests


Background: Defining vital sign thresholds has focused on mortality, which may be delayed for hour, days, or weeks following injury, limiting the immediate clinical significance. Objectives: To identify a systolic blood pressure (SBP) threshold indicating imminent cardiopulmonary arrest. Methods: This was a retrospective, observational study using data from adult helicopter emergency medical service (HEMS) patients suffering HEMS-witnessed arrest. We identified a subgroup of patients with shock-related arrest. Pre-arrest SBP values were plotted over time, with multiple linear regression used to define a best-fit curve to identify a “terminal inflection point” (slope = -1.0) beyond which cardiopulmonary arrest was imminent.

Collaboration of team and public.

A Novel Difficult-Airway Prediction Tool for Emergency Airway Management: Validation of the HEAVEN Criteria in a Large Air Medical Cohort


Edward Kuzmack, DO1, Travis Inglis, DO1, David Olvera, EMT-P, Allen Wolfe, RN, Kona Seng, DO1, and Daniel Davis, MD1,2,3 1Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California 2Air Methods Corporation, Englewood, Colorado 3California University of Science and Medicine, San Bernardino, California Abstract Background: Difficult-airway prediction tools help identify optimal airway techniques, but were […]

HEAVEN Criteria: Derivation of a New Difficult Airway Prediction Tool


Airway management is vitally important in the management of critically ill and injured patients. Current tools to predict the difficult airway have limited application in the emergency airway situation. The aim of this study was to derive a novel difficult airway prediction tool for emergency intubation. Methods: A retrospective descriptive analysis was performed in a population of air medical rapid sequence intubation patients requiring more than 1 attempt. The Delphi technique was used to classify the etiology for airway failure as reported by providers as part of a performance improvement database. Etiologies were organized into 6 categories, and an acronym was derived for ease of recall.
Results: A total of 504 patients were screened, with 63 (12%) patients identified in whom the initial intubation attempt was unsuccessful. All 63 patients (100%) were placed into 1 or more categories (HEAVEN criteria ¼ Hypoxemia, Extremes of size, Anatomic challenges, Vomit/blood/fluid, Exsanguina-tion/anemia, and Neck mobility issues). The database was relatively modest in size, and many patients had more than 1 criterion present, limiting our ability to perform prevalence calculations.
Conclusion: The HEAVEN criteria represent a set of difficult airway predictors that may be applied prospectively by emergency airway personnel, facilitating airway decision making. These criteria should be validated prospectively.