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IMACS Users’ Guide – Version 1.0 12/21/2012 Page 20 of 56 Pre-Implant Form Clinical Events and Interventions this hospitalization (Pre-implant): Pertaining to the implant hospitalization, select all other events that apply. IABP Dialysis Ultrafiltration Ventilator/ Intubation Feeding tube ECMO CABG Aortic Valve replacement / repair Mitral valve replacement / repair Congenital cardiac surg LVAD RVAD TAH Aneursyomectomy (DOR) Cardiac surgery, other Cardiac arrest Major MI Other surgical procedures Major infections Unknown None Infection Type Bacterial Fungal Viral Protozoan Unknown Infection Location Blood Endocarditis, native Line Sepsis Mediastinum Pneumonia Urine Unknown Other If event this hospitalization is Major Infection (new or ongoing), Select type of infection: Select the type of infection that occurred during the implant hospitalization. If event this hospitalization is Major Infection (new or ongoing), Select location of infection: Select the location of the infection that occurred during the implant hospitalization. If Other, specify is selected, type in the specification in the block provided (see lists above).
IMACS Users’ Guide – Version 1.0 12/21/2012 Page 21 of 56 Pre-Implant Form IV inotrope therapy within 48 hours of implant: If the patient has gone to the operating room for the purpose of the implant and is on intravenous inotropes of any sort, the answer should be Yes. If an agent is known to have been used but discontinued within 48 hours prior to arriving in the operating room, Yes should also be checked. If Yes, IV inotrope therapy agents: Check all intravenous inotropes used at the time of the MCSD implant that apply Dobutamine Dopamine Milrinone Levosimendan Epinephrine Norepinephrine Isoproterenol Other, specify Unknown INTERMACS Patient Profile at time of implant: Select one. These profiles will provide a general clinical description of the patients receiving primary LVAD or TAH implants. If there is significant clinical change between the initial decision to implant and the actual implant procedure, then the profile closest to the time of implant should be recorded. Patients admitted electively for implant should be described by the profile just prior to admission. INTERMACS 1: Critical cardiogenic shock describes a patient who is “crashing and burning”, in which a patient has life-threatening hypotension and rapidly escalating inotropic pressor support, with critical organ hypoperfusion often confirmed by worsening acidosis and lactate levels. This patient can have modifier A or TCS (see ‘Modifiers’ below) INTERMACS 2: Progressive decline describes a patient who has been demonstrated “dependent” on inotropic support but nonetheless shows signs of continuing deterioration in nutrition, renal function, fluid retention, or other major status indicator. Patient profile 2 can also describe a patient with refractory volume overload, perhaps with evidence of impaired perfusion, in whom inotropic infusions cannot be maintained due to tachyarrhythmias, clinical ischemia, or other intolerance. This patient can have modifier A or TCS. INTERMACS 3: Stable but inotrope dependent describes a patient who is clinically stable on mild-moderate doses of intravenous inotropes (or has a temporary circulatory support device) after repeated documentation of failure to wean without symptomatic hypotension, worsening symptoms, or progressive organ dysfunction (usually renal). It is critical to monitor nutrition, renal function, fluid balance, and overall status carefully in order to distinguish between a patient who is truly stable at Patient Profile 3 and a patient who has unappreciated decline rendering them Patient Profile 2. This patient may be either at home or in the hospital. Patient Profile 3 can have modifier A, and if in the hospital with circulatory support can have modifier TCS.
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