HEAVEN CRITERIA vs Modified LEMON Score for Predicting Difficult Intubation

Study Overview
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Brief Summary
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Emergency tracheal intubation is a lifesaving procedure frequently performed on critically ill and injured patients in the emergency department (ED). Emergency intubations are more difficult than elective intubations in the operating room setting because of the sicker patient population with a limited physiologic reserve and less controlled setting in the ED. Indeed, the proportion of difficult intubation ranges from 10% to 27% in the ED setting , whereas the rate ranges from 1% to 9% of elective intubation in the anaesthesia setting. Because emerging evidence demonstrates that repeated intubation attempts are associated with an increased risk of adverse events, early recognition of difficulty intubation with a systematic use of rescue methods in ED patients is critical. The commonest airway prediction tool is the LEMON score. In the modified LEMON score Mallampati was excluded as it was not a pragmatic assessment in the ED. Existing difficult airway prediction tools were derived in the elective surgery environment and may not be applicable to emergency airway management. LEMON criteria was designed for preoperative clinical setting. Hence in this study we are observing if HEAVEN (H- Hypoxemia E - extremes of age A - anatomical abnormalities V - vomit/ blood / fluid E - Exsanguination/anaemia N - neck mobility issues) is a better tool for predicting difficult intubatio.

Official Title
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Cross Sectional Study to Determine Whether HEAVEN CRITERIA is a Better Tool Than Modified LEMON Score for Predicting Difficult Intubation in In-hospital Emergency Airway Management

Conditions
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Intubation; Difficult or Failed, Intubation Complication

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 1. All patients who undergo an endotracheal intubation in the emergency medicine department and 2. who legally give consent for the study or relatives give consent Exclusion Criteria: Patients not consenting for the study or · Patients in cardio respiratory arrest
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| First attempt intubation success rate |  | Two hours | 
| Physicians assessment of intubation as easy or difficult |  | Two hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total attempts of intubation. |  | Two hours | 
| Patients requiring vasoconstrictors undergoing endotracheal intubation |  | Two hours | 
| Patients requiring rescue airway devices ( eg.LMA) / emergency front of neck access. |  | Two hours | 
| Patients with suspicion of aspiration during endotracheal intubation |  | Two hours | 
| Which criteria was the most frequent in causing difficult airway among HEAVEN |  | Two hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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HEAVEN criteria, Modified LEMON, Difficult airway, Prediction tool