K Number
K103191
Device Name
QUADROX-I PEDIATRIC MICROPOROUS MEMBRANE OXYGENATOR WITH INTEGRATED ARTERIAL FILTER WITH SOFTLINE / BIOLINE COATING
Date Cleared
2011-03-08

(131 days)

Product Code
Regulation Number
870.4350
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The membrane oxygenator QUADROX-i Pediatric is intended for use in extracorporeal circulation during cardiopulmonary bypass in cardiac surgery. It is designed for a blood flow rate of 0.2 - 2.8 l/min and is intended for the treatment of pediatric patients. Within the specified flow rate range, the device oxygenates the blood, removes carbon dioxide and regulates the blood temperature. The QUADROX-i Pediatric (HMO 31000) model with integrated arterial filter also filters air bubbles and particles larger than 33 um. The utilization period of this device is restricted to six hours. Responsibility for deciding whether to use an oxygenator rests solely with the attending physician.
Device Description
The QUADROX-i Pediatric Oxygenator is a blood-gas exchanger with integrated heat exchanger and optional integrated arterial filter, intended for the treatment of pediatric patients (children). The Oxygenator is designed for a blood flow range from 0.2 to 2.8 I/min. Since these patients have a very small blood volume of their own, the small priming volume of the oxygenator is an important parameter. The priming volume is 81 ml for the version without integrated arterial filter. The version with integrated arterial filter has a priming volume of 99 ml. The effective gas exchange surface is 0.8 m²; the one for the heat exchanger is 0.15 m². The integrated arterial filter is composed of a planar area from a woven 33 micron filter. The filter surface is 55 cm2. The blood contacting surfaces are coated with SOFTLINE coating or with BIOLINE Coating. The QUADROX-i Pediatric oxygenator is a sterile and non-pyrogenic device, for single use only and is not to be re-sterilized by the user.
More Information

Not Found

No
The summary describes a mechanical device for extracorporeal circulation and does not mention any AI or ML components or functionalities.

Yes
The device is described as an "oxygenator" used in "cardiopulmonary bypass in cardiac surgery" which "oxygenates the blood, removes carbon dioxide and regulates the blood temperature." These functions directly treat the patient's physiological state, making it a therapeutic device.

No.

Explanation: The device is an oxygenator used for extracorporeal circulation during cardiopulmonary bypass, which provides blood oxygenation, carbon dioxide removal, and temperature regulation. These are therapeutic functions rather than diagnostic ones.

No

The device description clearly outlines physical components like a blood-gas exchanger, heat exchanger, and optional integrated arterial filter, indicating it is a hardware device.

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

Here's why:

  • Intended Use: The intended use is for extracorporeal circulation during cardiopulmonary bypass in cardiac surgery. This is a therapeutic procedure performed directly on the patient's blood outside the body, not a diagnostic test performed on a sample of blood or other bodily fluid to provide information about a patient's health status.
  • Device Description: The device is described as a blood-gas exchanger with integrated heat exchanger and optional integrated arterial filter. Its function is to oxygenate blood, remove carbon dioxide, and regulate temperature, all of which are therapeutic actions.
  • No mention of diagnostic testing: The text does not describe any function related to analyzing blood or other samples to diagnose a condition or provide diagnostic information.

IVD devices are specifically designed to perform tests on samples taken from the human body to provide information for diagnostic purposes. This device's purpose is to support the patient's physiological functions during surgery.

N/A

Intended Use / Indications for Use

The membrane oxygenator QUADROX-i Pediatric is intended for use in extracorporeal circulation during cardiopulmonary bypass in cardiac surgery. It is designed for a blood flow rate of 0.2 - 2.8 I/min and is intended for the treatment of pediatric patients. Within the specified flow rate range, the device oxygenates the blood, removes carbon dioxide and regulates the blood temperature.

The QUADROX-i Pediatric (HMO 31000) model with integrated arterial filter also filters air bubbles and particles larger than 33 um.

The utilization period of this device is restricted to six hours.

Responsibility for deciding whether to use an oxygenator rests solely with the attending physician.

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

DTZ, DTR, DTM

Device Description

The QUADROX-i Pediatric Oxygenator is a blood-gas exchanger with integrated heat exchanger and optional integrated arterial filter, intended for the treatment of pediatric patients (children). The Oxygenator is designed for a blood flow range from 0.2 to 2.8 I/min. Since these patients have a very small blood volume of their own, the small priming volume of the oxygenator is an important parameter. The priming volume is 81 ml for the version without integrated arterial filter. The version with integrated arterial filter has a priming volume of 99 ml.

The effective gas exchange surface is 0.8 m²; the one for the heat exchanger is 0.15 m². The integrated arterial filter is composed of a planar area from a woven 33 micron filter. The filter surface is 55 cm2.

The blood contacting surfaces are coated with SOFTLINE coating or with BIOLINE Coating.

The QUADROX-i Pediatric oxygenator is a sterile and non-pyrogenic device, for single use only and is not to be re-sterilized by the user.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

pediatric patients (children)

Intended User / Care Setting

extracorporeal circulation during cardiopulmonary bypass in cardiac surgery.

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)

Non-clinical Testing:

The QUADROX-i Pediatric Microporous Membrane Oxygenator with and without Integrated Arterial Filter with Softline Coating and with BIOLINE Coating have been tested or evaluated for compliance to ISO 10993-1 Biologic Evaluation of Medical Devices, ISO 7199 "Cardiovascular implants and artificial organs - blood gas exchangers (oxygenators) as well as the requirements of ISO 15675 "Cardiovascular implants and artificial organs -Cardiopulmonary Bypass - Arterial line blood filters". The products met these requirements.

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.

D101 KIDS Infant Hollow Eiber Oxygenator with Ph.J.S.I.O. Coating, Sorin Group Italia S.R.L., K072091, Capiox Arterial Filter, CX*AF02, Terumo Cardiovascular Systems Corp., K943917, QUADROX-i Adult microporous membrane oxygenator with and without integrated arterial filter with SOFTLINE coating, MAQUET Cardiopulmonary AG, K082117, QUADROX-i Adult Microporous Membrane Oxygenator with and without Arterial Filter with Bioline Coating, MAQUET Cardiopulmonary AG, K090511, QUADROX-iD Pediatric Diffusion Membrane Oxygenator with BIOLINE Coating, MAQUET Cardiopulmonary AG, K100278, Medos Hilite Hollow Fiber Oxygenator, model 2800 LT, Gish Biomedical Inc., K090450

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

§ 870.4350 Cardiopulmonary bypass oxygenator.

(a)
Identification. A cardiopulmonary bypass oxygenator is a device used to exchange gases between blood and a gaseous environment to satisfy the gas exchange needs of a patient during open-heart surgery.(b)
Classification. Class II (special controls). The special control for this device is the FDA guidance document entitled “Guidance for Cardiopulmonary Bypass Oxygenators 510(k) Submissions.”

0

MAQUET GETINGE GROUP

K103191

MAR - 8 2011

510 (K) Summary [as required by 21 CFR 807.92(c) ]

MAQUET Cardiopulmonary AG Hechinger Strasse 38 72145 Hirrlingen Germany

Contact Person: Katrin Schwenkglenks Phone: +49 7478 921-151 +49 7478 921-400 Fax: E-mail: katrin.schwenkglenks@maquet-cp.com

Date Prepared:

Submitter:

October 22, 2010

Device Trade Name:

QUADROX-i Pediatric Microporous Membrane Oxygenator with and without integrated Arterial Filter with SOFTLINE Coating and with BIOLINE Coating

Common/Usual name: Oxygenator with integrated heat exchanger and optional integrated arterial filter

Classification names:

Oxygenator, cardiopulmonary bypass Heat Exchanger, cardiopulmonary bypass Filter, blood, cardiopulmonary bypass, arterial line

Predicate Devices:

D101 KIDS Infant Hollow Eiber Oxygenator with Ph.J.S.I.O. Coating, Sorin Group Italia S.R.L., K072091,

Capiox Arterial Filter, CX*AF02, Terumo Cardiovascular Systems Corp., K943917,

QUADROX-i Adult microporous membrane oxygenator with and without integrated arterial filter with SOFTLINE coating, MAQUET Cardiopulmonary AG, K082117,

QUADROX-i Adult Microporous Membrane Oxygenator with and without Arterial Filter with Bioline Coating, MAQUET Cardiopulmonary AG, K090511,

1

Image /page/1/Picture/0 description: The image shows the logo for Maquet Getinge Group. The word "MAQUET" is in large, bold, sans-serif font on the top line. Below that, "GETINGE GROUP" is in a smaller, sans-serif font. The logo is in black and white.

QUADROX-iD Pediatric Diffusion Membrane Oxygenator with BIOLINE Coating, MAQUET Cardiopulmonary AG, K100278 .

Medos Hilite Hollow Fiber Oxygenator, model 2800 LT, Gish Biomedical Inc., K090450

Device Description:

The QUADROX-i Pediatric Oxygenator is a blood-gas exchanger with integrated heat exchanger and optional integrated arterial filter, intended for the treatment of pediatric patients (children). The Oxygenator is designed for a blood flow range from 0.2 to 2.8 I/min. Since these patients have a very small blood volume of their own, the small priming volume of the oxygenator is an important parameter. The priming volume is 81 ml for the version without integrated arterial filter. The version with integrated arterial filter has a priming volume of 99 ml.

The effective gas exchange surface is 0.8 m²; the one for the heat exchanger is 0.15 m². The integrated arterial filter is composed of a planar area from a woven 33 micron filter. The filter surface is 55 cm2.

The blood contacting surfaces are coated with SOFTLINE coating or with BIOLINE Coating.

The QUADROX-i Pediatric oxygenator is a sterile and non-pyrogenic device, for single use only and is not to be re-sterilized by the user.

Indications for Use:

The membrane oxygenator QUADROX-i Pediatric is intended for use in extracorporeal circulation during cardiopulmonary bypass in cardiac surgery. It is designed for a blood flow rate of 0.2 - 2.8 l/min and is intended for the treatment of pediatric patients. Within the specified flow rate range, the device oxygenates the blood, removes carbon dioxide and requlates the blood temperature.

The QUADROX-i Pediatric (HMO 31000) model with integrated arterial filter also filters air bubbles and particles larger than 33 um.

The utilization period of this device is restricted to six hours.

Responsibility for deciding whether to use an oxygenator rests solely with the attending physician.

2

Statement of Technical Comparison:

QUADROX-i Pediatric Microporous Membrane The Oxygenator ાં ક comparable to the QUADROX-i Adult Microporous Membrane Oxygenator regarding the design principles, biocompatibility and sterility process. Both products come with and without an Integrated Arterial Filter with Softline Coating. The Softline Coating and the BIOLINE Coating are the same coatings contained in the QUADROX-i Adult Oxygenator.

Non-clinical Testing:

The QUADROX-i Pediatric Microporous Membrane Oxygenator with and without Integrated Arterial Filter with Softline Coating and with BIOLINE Coating have been tested or evaluated for compliance to ISO 10993-1 Biologic Evaluation of Medical Devices, ISO 7199 "Cardiovascular implants and artificial organs - blood gas exchangers (oxygenators) as well as the requirements of ISO 15675 "Cardiovascular implants and artificial organs -Cardiopulmonary Bypass - Arterial line blood filters". The products met these requirements.

Determination of Substantial Equivalence

Testing and evaluation on safety and effectiveness was conducted to demonstrate that the QUADROX-i Pediatric Microporous Membrane Oxygenator with and without Integrated Arterial Filter with SOFTLINE Coating and BIOLINE Coating is substantially equivalent to the D101 KIDS Infant Hollow Fiber Oxygenator with Ph.I.S.I.O. Coating from Sorin as well as to the Capiox Arterial Filter, CX*AF02 from Terumo.

The following areas have been tested or evaluated:

  • Indications for Use
  • Integrity
  • Performance
  • Biocompatibility
  • Sterility .

Conclusion

The data given demonstrate that the QUADROX-i Pediatric Microporous Membrane Oxygenator with and without Integrated Arterial Filter with Softline Coating and with BIOLINE Coating is substantially equivalent to the named predicate devices which currently hold market clearance.

3

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/3/Picture/1 description: The image shows the logo for the Department of Health & Human Services USA. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" arranged around the perimeter. Inside the circle is an emblem featuring a stylized eagle or bird-like figure with three curved lines representing its wings or feathers. The emblem is black, and the text is also in black against a white background.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room -WO66-G609 Silver Spring, MD 20993-0002

Maquet Cardiopulmonary AG c/o Ms. Katrin Schwenkglenks Hechinger Strasse 38 D-72145 Hirrlingen, Germany

MAR - 8 2011

Re: K103191

Trade/Device Name: QUADROX-i Pediatric Microporous Membrane Oxygenator with Integrated Arterial Filter with SOFTLINE COATING (HMO 31000), QUADROX-i Pediatric Microporous Membrane Oxygenator with SOFTLINE COATING (HMO 30000), QUADROX-i Pediatric Microporous Membrane Oxygenator with Integrated Arterial Filter with BIOLINE COATING (BE-HMO 31000, BEQ-HMO 31000), and Artonal Price Microporous Membrane Oxygenator with BIOLINE COATING (BEQ-HMO 30000, BE-HMO 30000) Regulation Number: 21 CFR 870.4350 Regulation Name: Cardiopulmonary bypass oxygenator Regulatory Class: II Product Code: DTZ, DTR, DTM Dated: February 21, 2011

Received: February 24, 2011

Dear Ms. Schwenkglenks:

We have reviewed your Section 510(k) premarket notification of intent to market the device we nave reviewed your bootion of the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate 101 use stated in the encrosure) to regally the Medical Device Amendments, or to commerce pror to May 20, 1977, 1978, in accordance with the provisions of the Federal Food, Drug, devices mat have been require approval of a premarket approval application (PMA). alle Costience Act (710) that do not require to the general controls provisions of the Act. The r ou may, merciors, manter att a Act include requirements for annual registration, listing of general controls provinces of the ling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability adulteration. Tease note: ODTET doss not be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it If your device is classified (500 above) institute major regulations affecting your device can be may be subject to additional controls: "Intering and one" - "
found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may found in the Code of I casia. Registerning your device in the Federal Register.

4

Page 2 - Ms. Katrin Schwenkglenks

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); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); 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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

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) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevices/Resourcesfor You/Industry/default.htm.

Sincerely vours.

h R. hohmen

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

Enclosure

5

Indications for Use

510(k) Number (if known):

Device Name: QUADROX-i Pediatric Microporous Membrane Oxygenator with and without integrated Arterial Filter

Indications for Use:

The membrane oxygenator QUADROX-i Pediatric is intended for use in extracorporeal circulation during cardiopulmonary bypass in cardiac surgery. It is designed for a blood flow rate of 0.2 - 2.8 I/min and is intended for the treatment of pediatric patients. Within the specified flow rate range, the device oxygenates the blood, removes carbon dioxide and regulates the blood temperature.

The QUADROX-i Pediatric (HMO 31000) model with integrated arterial filter also filters air bubbles and particles larger than 33 um.

The utilization period of this device is restricted to six hours.

Responsibility for deciding whether to use an oxygenator rests solely with the attending physician.

Prescription Use × (Part 21 CFR 801 Subpart D)

AND/OR

Over-The-Counter Use (21 CFR 801 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE OF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

s R.V. Aumer

on Sign-Off (Division Sigm-Sign-Silver Devices

510(k) Number KID 21 Ju

Page 1 of 1