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Airway

EASy PDA

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Echocardiography Assessment using Subcostal-only-view in the Physiologically Difficult Airway

EASy-PDA brings rapid cardiopulmonary and gastric ultrasound to emergency airway management. Performed before intubation, it assigns a hemodynamic phenotype and screens for a full stomach — so the plan can be tailored to a critically ill patient’s tenuous physiology and prevent peri-intubation cardiovascular collapse.

Why the physiologically difficult airway matters

Before intubation, know the physiology.

43%

of critically ill patients suffered peri-intubation cardiovascular instability in the international INTUBE study

3%

suffered peri-intubation cardiac arrest

37.5% vs 24.6%

28-day mortality with vs without peri-intubation instability

Diagnostic information to optimize these patients before the procedure is often lacking. EASy-PDA is a ~2.4-minute pre-induction scan that assigns the hemodynamic phenotype and screens the stomach — before the drugs are drawn.

The EASy-PDA examination

A subxiphoid-anchored exam completed in ~2.4 minutes (mean), interpreted by hemodynamic pattern.

Subcostal 4-chamber (SC4C)

Biventricular chamber size, wall thickness, and function → hemodynamic phenotype

IVC

Size and collapsibility → intravascular volume status

Upper lung fields & pleura

B-lines, effusion, pneumothorax before positive-pressure ventilation

Gastric antrum

Full-stomach / aspiration risk assessment before intubation

How it changes management

Assign a hemodynamic phenotype before induction (biventricular function + volume status)
Tailor pre-induction optimization: fluids, vasopressors, or inotropes
Identify a full stomach and consider gastric decompression before intubation
Detect tamponade or tension physiology that needs intervention first
Shares the EASy subcostal framework — fast and learnable in time-critical settings

High-risk findings

EASy-PDA findings that flag high risk for peri-intubation collapse:

Severely reduced LV function

Induction agents worsen cardiac output

RV dilation with septal bowing

Positive-pressure ventilation reduces venous return

Flat, collapsible IVC

Profound hypovolemia — volume before induction

Pericardial effusion with tamponade physiology

May need intervention before intubation

Full gastric antrum

High aspiration risk — consider decompression first

Evidence

Case series: 30 critically ill patients needing emergency airway management outside the OR, scanned by trained anesthesiology residents before induction.

2.40 min

mean time to complete the exam

86.7%

of exams (26/30) yielded findings sufficient to inform management

3

interventions prompted before intubation — an emergent pericardial window (1) and gastric decompression (2)

Bughrara N, Tso MS, Weigand ME, et al. Integrating Rapid Cardiopulmonary and Gastric Ultrasound for Emergency Airway Management in Critically Ill Patients (EASy-PDA). Crit Care Explor. 2025;7(11):e1340.

Learn EASy PDA

Watch the tutorial videos and explore clinical scenarios.