MDCalc

HEAVEN Criteria

Assesses the risk of a difficult airway in patients undergoing emergency intubation.

Hypoxemia

Oxygen saturation value ≤93% at the time of initial laryngoscopy

Extremes of size

Pediatric patient ≤8 years of age or clinical obesity

Anatomic challenge

Include trauma, mass, swelling, foreign body, or other structural abnormality limiting laryngoscopic view

Vomit/blood/fluid 

Clinically significant fluid present in the pharynx/hypopharynx at the time of laryngoscopy

Exsanguination

Suspected anemia that could potentially accelerate desaturation during RSI-associated apnea

Neck

Limited cervical range-of-motion due to immobilization or arthritis

Result:

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Advice

Use this tool to guide intubation preparation and backup planning, alongside clinical judgment.

Management

More positive criteria correlate with lower first-attempt RSI success; consider:

  • Adjuncts such as video laryngoscopy or gum-elastic bougie.
  • Alternative strategies such as delayed-sequence intubation or surgical cricothyrotomy.