Dautzenberg et al modified the Pre-Arrest Morbidity Index (PAM, see 06.25.04) for evaluating patients who have undergone cardiopulmonary resuscitation in the hospital. This can help in the decision whether or not to continue resuscitation, especially in the elderly. The authors are from Bosch Medicentrum, Slotervaart Hospital Amsterdam, Free University of Amsterdam, University Hospital Utrecht and the University of South Florida.
Parameters:
(1) hypotension
(2) azotemia/uremia
(3) malignancy
(4) pneumonia
(5) homebound lifestyle
(6) angina pectoris
(7) acute myocardial infarction (AMI)
(8) heart failure
(9) oliguria
(10) sepsis
(11) need for mechanical ventilation
(12) recent stroke or cerebrovascular event
(13) coma
(14) age
(15) S3 gallop
(16) dementia
|
Clinical Finding |
Status |
Points |
|
hypotension |
absent |
0 |
|
|
present |
3 |
|
azotemia |
absent |
0 |
|
|
present |
2 |
|
malignancy |
absent |
0 |
|
|
present |
2 |
|
pneumonia (on admission) |
absent |
0 |
|
|
present |
2 |
|
homebound lifestyle |
absent |
0 |
|
|
present |
2 |
|
angina pectoris |
absent |
0 |
|
|
present |
1 |
|
acute myocardial infarction |
none |
0 |
|
|
within 2 days of hospital admission |
0 |
|
|
after 2 days from admission |
1 |
|
heart failure of NYHA class III or IV |
absent |
0 |
|
|
present |
1 |
|
olguria |
absent |
0 |
|
|
present |
1 |
|
sepsis (on admission) |
absent |
0 |
|
|
present |
1 |
|
need for mechanical ventilation |
absent |
0 |
|
|
present |
1 |
|
recent cerebrovascular event |
absent |
0 |
|
|
present |
2 |
|
coma |
absent |
0 |
|
|
present |
1 |
|
age |
<= 70 years |
0 |
|
|
> 70 years |
1 |
|
S3 gallop |
absent |
0 |
|
|
present |
1 |
|
dementia |
absent |
0 |
|
|
present |
2 |
where:
• Hypotension is defined as a systolic blood pressure <= 90 mm Hg (George et al, 1989, page 29).
• Azotemia is defined as a BUN >= 50 mg/dL or serum creatinine >= 2.5 mg/dL (George et al, 1989, page 29).
• Oliguria is defined as < 300 mL urine output per day (George et al, 1989, page 29).
• NYHA is the New York Heart Association.
• Changes from the original PAM include (a) removal cirrhosis, (b) addition dementia, (c) addition age, (d) dating AMI, (e) points assigned
• Dementia is indicated by the inability to recognize family or friends.
modified PAM index =
= SUM(points for all 16 clinical findings present)
Interpretation:
• minimum index: 0
• maximum index: 24
In Bowker and Stewart the following mortality rate was associated with the MPI:
|
MPI Score |
Mortality |
|
0 |
55% |
|
1 |
75% |
|
2 |
80% |
|
3 |
86% |
|
4 |
91% |
|
5 |
98% |
|
6 |
95% |
|
>= 7 |
100% |
from Figure 3, page 92.
Specialty: Cardiology
ICD-10: ,
