HEAVEN Criteria: Derivation of a New Difficult Airway Prediction Tool


Daniel P. Davis, MD 1, 2, David J. Olvera, NRP, FP-C, CMTE

1 Research Director, Department of Emergency Medicine, Arrowhead Regional Medical Center, San Bernardino, CA

2 Scientific Advisor, Air Methods Corporation, Englewood, CO


Objective: 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 = Hypoxemia, Extremes of size, Anatomic challenges, Vomit/blood/fluid, Exsanguination/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.

Click below to read the full research paper published by Air Medical Journal, Volume 36, Issue 4, P195-197, July 01, 2017