K Number
K023683
Device Name
MULTI-STRAP FULL FACE MASK
Date Cleared
2003-12-01

(395 days)

Product Code
Regulation Number
868.5905
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
A patient interface accessory for use with CPAP and bi-level systems used in the treatment of adult OSA and / or ventilatory support. A minimum pressure of > 3.0 cm H₂O at the mask is required. Single patient, multi-use
Device Description
The EMS Multi-strap Full Face mask covers both the nose and mouth and includes a nonrebreathing / anti-asphyxia valve, which is activated under flow / pressure from a CPAP or bilevel ventilator. It is open to ambient air when the ventilator is not ON allowing the patient to breath ambient air. It has a quick release mask harness system. It is single patient, multi-use.
More Information

Not Found

No
The description focuses on the mechanical components and function of a CPAP mask, with no mention of AI or ML.

No
This device is a patient interface accessory (a mask) for use with CPAP and bi-level systems, which are the therapeutic devices. The mask itself does not provide the therapy.

No
The device is described as a patient interface accessory (a mask) for use with CPAP and bi-level systems to treat adult OSA and/or provide ventilatory support. It does not mention any function related to diagnosing a condition.

No

The device description clearly describes a physical mask with hardware components (nonrebreathing/anti-asphyxia valve, quick release mask harness system) and does not mention any software functionality.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is for providing respiratory support (CPAP and bi-level) for the treatment of OSA and/or ventilatory support. This is a therapeutic application, not a diagnostic one.
  • Device Description: The description details a mask and valve system for delivering air pressure, which aligns with respiratory support devices.
  • Lack of Diagnostic Elements: There is no mention of analyzing biological samples (blood, urine, tissue, etc.) or providing diagnostic information about a patient's condition. IVDs are designed to perform tests on these types of samples to diagnose diseases or conditions.

Therefore, this device falls under the category of a medical device used for treatment, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

A patient interface accessory for use with CPAP and bi-level systems used in the treatment of adult OSA and / or ventilatory support. A minimum pressure of > 3.0 cm H₂O at the mask is required. Single patient, multi-use

Product codes (comma separated list FDA assigned to the subject device)

BZD

Device Description

The EMS Multi-strap Full Face mask covers both the nose and mouth and includes a nonrebreathing / anti-asphyxia valve, which is activated under flow / pressure from a CPAP or bilevel ventilator. It is open to ambient air when the ventilator is not ON allowing the patient to breath ambient air. It has a quick release mask harness system. It is single patient, multi-use.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Nose and mouth

Indicated Patient Age Range

Adult

Intended User / Care Setting

Hospital, Sub-acute Institutions, Home

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Not Found

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K982283, K961915, K982530

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 868.5905 Noncontinuous ventilator (IPPB).

(a)
Identification. A noncontinuous ventilator (intermittent positive pressure breathing-IPPB) is a device intended to deliver intermittently an aerosol to a patient's lungs or to assist a patient's breathing.(b)
Classification. Class II (performance standards).

0

DEC = 1 2003

2.1 510(k) Summary of Safety and Effectiveness

Engineered Medical Systems, Inc. 2055 Executive Dr. Indianapolis, IN 46241

K023683

Non-Confidential Summary of Safety and Effectiveness

Page 1 of 2 October 31, 2002

Engineered Medical SystemsTel (317) 246-5500
2055 Executive Dr.Fax (317) 246-5501
Indianapolis, IN 46241
Official Contact:Bonnie A. Holly - Quality Manager
Proprietary or Trade Name:Multi-strap Full Face Mask
Common/Usual Name:Full Face CPAP Mask
Classification Name:Non-continuous ventilator (IPPB) accessory
Predicate Devices:Caradyne - Whisperflow mask - K982283
Respironics - Spectrum Full Face Mask - K961915
ResMed -- Sullivan Mirage Full Face Mask - K982530

Device Description:

The EMS Multi-strap Full Face mask covers both the nose and mouth and includes a nonrebreathing / anti-asphyxia valve, which is activated under flow / pressure from a CPAP or bilevel ventilator. It is open to ambient air when the ventilator is not ON allowing the patient to breath ambient air. It has a quick release mask harness system. It is single patient, multi-use.

Intended Use:

| Indicated Use -- | A patient interface accessory for use with CPAP
and bi-level systems used in the treatment of adult
OSA and / or ventilatory support. |
|-----------------------|---------------------------------------------------------------------------------------------------------------------------------------------|
| | A minimum pressure of $\geq$ 3.0 cm H2O at the mask is
required. |
| Environment of Use -- | Hospital, Sub-acute Institutions, Home |

1

Non-Confidential Summary of Safety and Effectiveness Page 2 of 2 October 31, 2002

General Technical Characteristics

AttributeEMS – Proposed device
Indications for useA patient interface accessory for use with CPAP and bi-level systems used in the treatment of adult OSA and / or ventilatory support. A minimum pressure of > 3.0 cm H₂O at the mask is required.
Single patient, multi-useYes
PrescriptionYes
Intended populationAny patient
Intended Environment of UseHospital, Sub-acute Institutions, Home
Design
Mask covers nose and mouthYes
Quick release mask harnessYes
Non-rebreathing / anti-asphyxia valveYes
Must be used with exhalation valve in circuitYes
Open to ambient when ventilator offYes
Valve opens at > 3 cm H2OYes
Can be cleanedYes
Materials
Mask cone and Elbow - PCYes
Mask cushion - PVCYes
Flap valve - SiliconeYes
Performance Standards
None under Section 514Yes

Differences between Other Legally Marketed Predicate Devices

The data within the submission demonstrates that the proposed devices when compared to the predicate devices are safe and effective and are substantially cquivalent to the predicate devices.

2

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo is a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" around the perimeter. Inside the circle is a stylized image of an eagle with three stripes representing the three branches of government.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

DEC - 1 2003

Engineered Medical Systems, Inc. C/O Mr. Paul Dryden Regulatory Consultant Promedic, Inc. 6329 West Waterview Court McCordsville, Indiana 46055-9501

Re: K023683

Trade/Device Name: Multi-Strap Full Face Mask Regulation Number: 868.5905 Regulation Name: Non-Continuous Ventilator Regulatory Class: II Product Code: BZD Dated: October 8, 2003 Received: October 9, 2003

Dear Mr. Dryden:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into cither class II (Special Controls) or class III (PMA), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

3

Page 2 - Mr. Dryden

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at (301) 594-4646. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html.

Sincerely yours,

Susa Ruine

Chiu Lin, Ph.D. Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4


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___ ..._______________________________________________________________________________________________________________________________________________________________________

2.3 Indications for Use

Page 1 of 1

510(k) Number:K023683 (To be assigned)
Device Name:Multi-strap Full Face Mask
Intended Use:A patient interface accessory for use with CPAP
and bi-level systems used in the treatment of adult
OSA and / or ventilatory support.
A minimum pressure of > 3.0 cm H₂O at the mask is
required.
Single patient, multi-use

Concurrencc of CDRH, Office of Device Evaluation (ODE)

Fisther

(Division Sign-Off) (Division Sign-Off)
Division of Anesthesiology, General Hospital, Infection Control, Dental Devices

510(k) Number: K823683

Prescription Use (Per CFR 801.109)

or

Over-the-counter use _