K Number
K031636
Device Name
CS100 INTRA-AORTIC BALLOON PUMP, MODEL 0998-00-3013-XX
Manufacturer
Date Cleared
2003-08-11

(76 days)

Product Code
Regulation Number
870.3535
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The balloon pump is an electromechanical system used to inflate and deflate intra-aortic balloons. It provides temporary support to the left ventricle via the principle of counterpulsation. The intra-aortic balloon is placed in the descending aorta, just distal to the left subclavian artery. Once the balloon is positioned, the pump is adjusted to trigger in synchrony with the ECG or arterial pressure waveform to ensure that inflation and deflation occur at the appropriate points during the cardiac cycle.
Device Description
The CS100 Intra-Aortic Balloon Pump ( IABP) is a cardiac assist device. It supports the heart's left ventricle by increasing coronary perfusion and reducing left ventricular work. The CS100 is equipped with the flexibility to aid medical staff in supporting a broad range of patients. It is also designed to work in conditions which are unique to the operating room, catheterization laboratory, critical care unit and transport. The CS100 IABP has three operation modes; auto, semi auto and manual. The auto operation mode provides simplicity and minimizes operator intervention. The semi-auto and manual operation modes provide operators with flexibility for difficult clinical cases.
More Information

Not Found

No
The document describes an electromechanical system that synchronizes with physiological signals (ECG or arterial pressure) using defined operational modes (auto, semi-auto, manual). There is no mention of AI, ML, or related concepts, nor any description of training or test data sets typically associated with AI/ML development. The "auto operation mode" is described as providing simplicity and minimizing operator intervention, which is consistent with automated control logic rather than AI/ML.

Yes
The device is described as providing "temporary support to the left ventricle," a "cardiac assist device," and supports the heart by "increasing coronary perfusion and reducing left ventricular work," all of which are therapeutic actions.

No

The device is described as a "cardiac assist device" that provides "temporary support to the left ventricle via the principle of counterpulsation." Its function is to inflate and deflate intra-aortic balloons, not to diagnose a condition.

No

The device description explicitly states it is an "electromechanical system" and a "cardiac assist device," indicating it includes hardware components beyond just software. The performance studies also mention "Hardware and software testing" and "Hardware and Software validation."

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

Here's why:

  • IVD Definition: In vitro diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections. They are used to provide information for diagnosis, monitoring, or screening.
  • Device Function: The description clearly states that the balloon pump is an electromechanical system that inflates and deflates an intra-aortic balloon within the patient's body. It provides mechanical support to the heart.
  • No Sample Analysis: There is no mention of the device analyzing any biological samples taken from the patient. Its function is entirely based on interacting with the patient's circulatory system directly.

Therefore, the CS100 Intra-Aortic Balloon Pump is a therapeutic and supportive medical device, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The balloon pump is an electromechanical system used to inflate and deflate intra-aortic balloons. It provides temporary support to the left ventricle via the principle of counterpulsation. The intra-aortic balloon is placed in the descending aorta, just distal to the left subclavian artery. Once the balloon is positioned, the pump is adjusted to trigger in synchrony with the ECG or arterial pressure waveform to ensure that inflation and deflation occur at the appropriate points during the cardiac cycle. The target populations are adult and pediatric. The balloon pump is intended for use in the health care facility setting.

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

DSP

Device Description

The CS100 Intra-Aortic Balloon Pump ( IABP) is a cardiac assist device. It supports the heart's left ventricle by increasing coronary perfusion and reducing left ventricular work. The CS100 is equipped with the flexibility to aid medical staff in supporting a broad range of patients. It is also designed to work in conditions which are unique to the operating room, catheterization laboratory, critical care unit and transport. The CS100 IABP has three operation modes; auto, semi auto and manual. The auto operation mode provides simplicity and minimizes operator intervention. The semi-auto and manual operation modes provide operators with flexibility for difficult clinical cases.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

descending aorta, just distal to the left subclavian artery

Indicated Patient Age Range

adult and pediatric

Intended User / Care Setting

health care facility setting

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)

The CS100 Intra-Aortic Balloon Pump complies with the voluntary standards identified in section six of this submission. Datascope's product development process required that the following activities be completed during the development of the CS100 Intra-Aortic Balloon Pump.
• Requirements specification review
• Hardware and software testing
• Code design and code reviews
• Environmental testing
• Safety testing
• Performance testing
• Hardware and Software validation
• Auto Operation Mode
The results of all measurements demonstrated that the CS 100 Intra-Aortic Balloon Pump is as safe, as effective and performs as well as the predicate devices.

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.

K965236, K983866

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

§ 870.3535 Intra-aortic balloon and control system.

(a)
Identification. An intra-aortic balloon and control system is a prescription device that consists of an inflatable balloon, which is placed in the aorta to improve cardiovascular functioning during certain life-threatening emergencies, and a control system for regulating the inflation and deflation of the balloon. The control system, which monitors and is synchronized with the electrocardiogram, provides a means for setting the inflation and deflation of the balloon with the cardiac cycle.(b)
Classification. (1) Class II (special controls) when the device is indicated for acute coronary syndrome, cardiac and non-cardiac surgery, or complications of heart failure. The special controls for this device are:(i) Appropriate analysis and non-clinical testing must be conducted to validate electromagnetic compatibility and electrical safety of the device;
(ii) Software verification, validation, and hazard analysis must be performed;
(iii) The device must be demonstrated to be biocompatible;
(iv) Sterility and shelf-life testing must demonstrate the sterility of patient-contacting components and the shelf life of these components;
(v) Non-clinical performance evaluation of the device must demonstrate mechanical integrity, durability, and reliability to support its intended purpose; and
(vi) Labeling must include a detailed summary of the device- and procedure-related complications pertinent to use of the device.
(2) Class III (premarket approval) when the device is indicated for septic shock and pulsatile flow generation.
(c)
Date premarket approval application (PMA) or notice of completion of product development protocol (PDP) is required. A PMA or notice of completion of a PDP is required to be filed with the Food and Drug Administration on or before March 31, 2014, for any intra-aortic balloon and control system indicated for septic shock or pulsatile flow generation that was in commercial distribution before May 28, 1976, or that has, on or before March 31, 2014, been found to be substantially equivalent to any intra-aortic balloon and control system indicated for septic shock or pulsatile flow generation that was in commercial distribution before May 28, 1976. Any other intra-aortic balloon and control system indicated for septic shock or pulsatile flow generation shall have an approved PMA or declared completed PDP in effect before being placed in commercial distribution.

0

K031636

AUG 1 1 2003 510(k) Summary of Safety and Effectiveness

Date:May 21, 2003
Submitter:Patient Monitoring Division
Datascope Corp.
Contact Person:Susan E. Mandy
Director, Clinical & Regulatory Affairs
Patient Monitoring Division
Datascope Corp.
Telephone: (201)995-8025
Fax:(201)995-8605
Device trade name: CS100 Intra-Aortic Balloon Pump
Common/usual name: Intra-aortic balloon and control system
Classification name:
21 CFR 870.3535Intra-aortic balloon and control system
Predicate Devices:K965236 System 96 Intra-Aortic Balloon Pump
K983866 Arrow AutoCAT Intra-Aortic Balloon Pump
Device Description:The CS100 Intra-Aortic Balloon Pump ( IABP) is a cardiac assist device.
It supports the heart's left ventricle by increasing coronary perfusion and
reducing left ventricular work. The CS100 is equipped with the flexibility
to aid medical staff in supporting a broad range of patients. It is also
designed to work in conditions which are unique to the operating room,
catheterization laboratory, critical care unit and transport. The CS100
IABP has three operation modes; auto, semi auto and manual. The auto
operation mode provides simplicity and minimizes operator intervention.
The semi-auto and manual operation modes provide operators with
flexibility for difficult clinical cases.
Intended Use:The balloon pump is an electromechanical system used to inflate and
deflate intra-aortic balloons. It provides temporary support to the left
ventricle via the principle of counterpulsation. The intra-aortic balloon is
placed in the descending aorta, just distal to the left subclavian artery.
Once the balloon is positioned, the pump is adjusted to trigger in
synchrony with the ECG or arterial pressure waveform to ensure that
inflation and deflation occur at the appropriate points during the cardiac
cycle. The target populations are adult and pediatric. The balloon pump is
intended for use in the health care facility setting.
Technology:The CS100 Intra-Aortic Balloon Pump ( IABP) is substantially equivalent
to the Datascope Corp. System 96 IABP, with the exception of the auto
operational mode which is equivalent to the auto operation mode of the
Arrow International AutoCAT IABP, which is manufactured by Belmont
Instrument Corporation. The CS100 has the same principles of operation
as the S96 IABP and the Arrow International AutoCAT IABP. The CS100
IABP is differentiated from the S96 IABP by its automated operation
option. The CS100 IABP also features improved ergonomics and a more
intuitive user interface than the System 96 IABP.
Test SummaryThe CS100 Intra-Aortic Balloon Pump complies with the voluntary
standards identified in section six of this submission. Datascope's
product development process required that the following activities be
completed during the development of the CS100 Intra-Aortic Balloon
Pump.
• Requirements specification review
• Hardware and software testing
• Code design and code reviews
• Environmental testing
• Safety testing
• Performance testing
• Hardware and Software validation
• Auto Operation Mode
ConclusionThe results of all measurements demonstrated that the CS 100 Intra-Aortic
Balloon Pump is as safe, as effective and performs as well as the predicate
devices.

1

:

2

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is a stylized image of three overlapping human profiles facing to the right.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

9 2003 SEP

Datascope Corp. Patient Monitoring Division c/o Ms. Susan E. Mandy Director, Clinical and Regulatory Affairs 800 MacArthur Blvd. Mahwan, N.J. 07430

Re: K031636

CS100 Intra-Aortic Balloon Pump Regulation Number: 21 CFR 870.3535 Regulation Name: Balloon, Intra-Aortic and Control System Regulatory Class: Class III (three) Product Code: DSP Dated: May 23, 2003 Received: May 27, 2003

Dear Ms. Mandy:

This letter corrects our substantially equivalent letter of August 11, 2003 regarding the incorrect address.

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 (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 either class II (Special Controls) or class III (PMA), it may be subject to 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.

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Page 2 - Ms. Susan E. Mandy

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 continue 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 and additionally Part 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4646. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers, International and Consumer Assistance at their toll free number (800) 638-2041 or at (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html.

Sincerely yours,

Roy D. Zutler, M.D.

Bram D. Zuckerman, M.D. Director Division of Cardiovascular Devices Office of Device Evaluation Center for Devices and Radiological Health

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INDICATION FOR USE

The balloon pump is an electromechanical system used to inflate and deflate intra-aortic balloons. It provides temporary support to the left ventricle via the principle of counterpulsation. The intra-aortic balloon is placed in the descending aorta, just distal to the left subclavian artery. Once the balloon is positioned, the pump is adjusted to trigger in synchrony with the ECG or arterial pressure waveform to ensure that inflation and deflation occur at the appropriate points during the cardiac cycle.

The target populations are adult and pediatric. The balloon pump is intended for use in the health care facility setting.

N. De Gortu

n Sian-Off n of Cardiovascular ices 510(k) Numbe

Prescription Use Only

25