The Pre-Arrest Morbidity (PAM) index can be used to predict survival in patients having a cardiopulmonary arrest in the hospital. The index is based on the present or absence of 15 clinical findings present before the arrest.
|
Clinical Finding |
Status |
Points |
|---|---|---|
|
hypotension |
absent |
0 |
|
|
present |
3 |
|
azotemia |
absent |
0 |
|
|
present |
3 |
|
malignancy |
absent |
0 |
|
|
present |
3 |
|
pneumonia (on admission) |
absent |
0 |
|
|
present |
3 |
|
homebound lifestyle |
absent |
0 |
|
|
present |
3 |
|
angina pectoris |
absent |
0 |
|
|
present |
1 |
|
acute myocardial infarction |
absent |
0 |
|
|
present |
1 |
|
heart failure of NYHA class III or IV |
absent |
0 |
|
|
present |
1 |
|
oliguria |
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 |
1 |
|
coma |
absent |
0 |
|
|
present |
1 |
|
cirrhosis |
absent |
0 |
|
|
present |
1 |
|
S3 gallop |
absent |
0 |
|
|
present |
1 |
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.
• George et al (1989) appears to be the first reference to the PAM index. They included the S3 gallop as a factor. Other articles do not include the S3 gallop and call themselves the "original" PAM index.
• Cohn et al included age > 60 years of age, but did not assign it any points if present.
PAM index =
= SUM(points for clinical findings present)
Interpretation:
• minimum score: 0
• maximum score: 25 (24 if S3 gallop not included)
|
Original PAM Index |
Survival |
|
0, 1, 2, 3 |
good |
|
4, 5 |
guarded |
|
6, 7, 8 |
poor |
|
>= 9 |
none |
Purpose: To use the PAM index to predict survival after resuscitation for a patient having an in-hospital cardiopulmonary arrest.
Specialty: Cardiology
Objective: risk factors, severity, prognosis, stage, complications
ICD-10: I46,
