Airway

EASy PDA

Case series

Acquire before induction → identify the physiologic vulnerability → optimize before you manage the airway.

Echocardiographic Assessment using Subxiphoid-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 identify potentially modifiable physiologic risk before intubation.

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

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.

EASy PDA Tool

Interactive POCUS-guided tool for the physiologically difficult airway. Enter heart, IVC, lung, and gastric findings to identify the phenotype and see the educational pre-induction considerations associated with it — right in your browser.

The EASy PDA examination

A subxiphoid-anchored exam completed in a mean of 2.4 minutes in the case series, interpreted by hemodynamic pattern.

Subcostal 4-chamber (SC4C)

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

IVC

Size and respiratory variation → venous filling and right-sided pressure context, read with the heart and lungs

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

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

This feasibility study showed that EASy-PDA findings informed management in 26 of 30 examinations. It was not designed to determine whether EASy-PDA reduces peri-intubation complications or improves outcomes — those studies are the next step.

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

Work through the training module and explore clinical scenarios.

Every EASy application is one loop of the same pathway. See the next step in the pathway