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HEAVEN criteria for difficult emergency airway
Six bedside factors predicting first-attempt failure during emergency intubation.
HEAVEN criteria for difficult emergency airway
Hypoxemia (SpO2 <=93% at the time of laryngoscopy)
Extremes of size (clinical obesity, or a paediatric patient <=8 years)
Anatomic challenge (trauma, mass, swelling, or other structural abnormality limiting the view)
Vomit, blood, or other fluid in the pharynx/hypopharynx at laryngoscopy
Exsanguination or suspected significant anaemia
Limited cervical range of motion (immobilisation or arthritis)
Result0 criteria
No HEAVEN criteria present; first-attempt success is expected to be high.
When to use
- Rapid bedside prediction of a difficult airway and lower first-pass success before emergency (out-of-hospital or ED) intubation.
Formula
Count of 6 criteria present (Hypoxemia, Extremes of size, Anatomic challenge, Vomit/blood/fluid, Exsanguination, Neck mobility limitation). Range 0-6.
Pearls and pitfalls
- Derived in an air-medical emergency intubation cohort; anticipate more airway equipment and personnel as the count rises.