PAM Score
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Select which is applicable
☐SBP<=90 mmHg
☐BUN>=17.9 mmol/L
☐Creatinine >= 220 µmol/L
☐Malignancy Present
☐Pneumonia
☐Homebound lifestyle (prior to admission)
☐Angina pectoris
☐Acute myocardial infarction
☐Heart Failure (NYHA Class III or IV)
☐S[3] gallop
☐Oliguria (<300 mL/day)
☐Sepsis
☐Mechanically ventilated
☐Recent stroke
☐Coma
☐Cirrhosis
R e s u l t s
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PAM Score
 
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PAM Score

The Pre-Arrest Morbidity (PAM) score was developed based upon 140 cardiac arrests in hospitalized patients who received CPR. This score is valuable in that the data for these items are present before CPR is required and patients can be identified in whom CPR is likely to be ineffective.

PAM score >=7 = <15% of being alive in 3 months

PAM score >8 = No patient survived to hospital discharge

15 items make up the PAM index

  • SBP <=90 mmHg [3 pts]
  • Azotemia [3 pts]
    • BUN >=50 mg/dL (17.9 mmol/L)
      AND/OR
    • Creatinine >=2.5 (220µmol/L)
  • Malignancy Present [3 pts]
  • Pneumonia [3 pts]
  • Homebound lifestyle (prior to admission) [3 pts]
  • Angina pectoris [1 pt]
  • Acute myocardial infarction [1 pt]
  • Heart Failure (NYHA Class III or IV) [1 pt]
  • S 3 gallop [1 pt]
  • Oliguria (<300 mL/day) [1 pt]
  • Sepsis [1 pt]
  • Mechanically ventilated [1 pt]
  • Recent stroke [1 pt]
  • Coma [1 pt]
  • Cirrhosis [1 pt]

The points are summed to come up with the PAM score which then predicts outcome.

Short term survival (were discharged from the hospital alive) in hospitalized patients who required CPR correlated well with the PAM score.

PAM Score %Short Term Survival
0 51%
1 45%
2 40%
3 34%
4 29%
5 23%
6 18%
7 12%
8 7%
>=9 0%

In this study, 55% of patients were resuscitated to the level of maintaining their own blood pressure for at least 1 hour, 24.3% were discharged from the hospital alive and 20.7% were still alive at 3 months after discharge.

Further factors after successful resuscitation that prognosticate a poor short term survival included:

  • Persistent hypotension (p <0.0001)
  • New-onset azotemia (p <0.0005)
  • Coma or confusion beyond 24 hours (p <0.00001)
  • Recent cardiopulmonary arrest (p <0.001)

Reference:

George AL, Folk BP, Crecelius PL, et al. Pre-arrest morbidity and other correlates of survival after in-hospital cardiopulmonary arrest. Am J Med. 1989;87(1):28-34.