K Number
K142103
Device Name
CUFF PILOT, SURE SEAL
Date Cleared
2015-05-08

(280 days)

Product Code
Regulation Number
868.5750
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
To monitor intra-cuff pressures of supraglottic airways. The SureSeal™ supraglottic airway with attached Cuff Pilot ™ is indicated for use in achieving and maintaining control of the airway during routine anesthetic procedures on fasted patients and emergency procedures using either spontaneous or Positive Pressure Ventilation (PPV). - An alternative to a face mask. - . An airway device in routine anesthesia procedures. - Securing the immediate airway in anticipated or unexpected difficult airway situations. - Use in elective surgical procedures where tracheal intubation is not necessary. - Establishing an immediate, clear airway during cardiopulmonary resuscitation (CPR) in the profoundly ● unconscious patient requiring artificial ventilation when tracheal intubation is not possible.
Device Description
The Cuff Pilot™ is a simple device which allows the user to monitor the cuff pressure of supraglottic airways. It has been designed to display pressure ranges via color coded zones. The Cuff Pilot™ is designed with an internal bellows, is compressed as pressure increases and expands when intra-cuff pressure is less. There is an O-ring indicator that is on the bellows and this indicates the status of pressure within the define color coded pressure zones. The SureSeal™ supraglottic airway is very similar in design, performance, indications for use, technology of operation, and materials to our LMA airways. It will have the Cuff Pilot™ attached and is considered MR Safe.
More Information

Easy Cuff – K102704, LMA™ Classic – K130304

Not Found

No
The device description focuses on a mechanical pressure indicator (bellows and O-ring) and color-coded zones. There is no mention of AI, ML, or any computational analysis of data.

No.

The device is designed to monitor intra-cuff pressures of supraglottic airways and assist in maintaining airway control, which are supportive functions but not direct therapeutic actions for treating a disease or condition.

No

The device is described as a monitor to display intra-cuff pressures of supraglottic airways and to maintain control of the airway. It does not diagnose a medical condition.

No

The device description clearly outlines a physical device ("internal bellows," "O-ring indicator") that mechanically monitors pressure and displays it via color-coded zones. There is no mention of software components.

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

Here's why:

  • Intended Use: The intended use is to monitor intra-cuff pressures of supraglottic airways and to provide an airway during medical procedures. This is a direct interaction with the patient's body for a therapeutic and monitoring purpose, not for examining specimens derived from the human body to provide information for diagnosis, monitoring, or compatibility testing.
  • Device Description: The device is a supraglottic airway with an attached pressure monitoring device. It works by physically interacting with the airway and measuring pressure within the cuff.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.), using reagents, or providing diagnostic information based on laboratory analysis.

The device is clearly intended for direct patient care and airway management, which falls outside the scope of In Vitro Diagnostics.

N/A

Intended Use / Indications for Use

Cuff Pilot™:
To monitor intra-cuff pressures of supraglottic airways.

Patient Population: Patients who have an artificial airway and for which the user would like to monitor cuff pressure, pediatric to adult.

Environments of Use: To be used under medical supervision in hospital (EMS), extended care facilities and outpatient clinics, where a patient may have an artificial airway. It may also be used in MRI suites when attached to airways that are MR conditional or MR Safe.

SureSeal™ with Cuff Pilot™:
The SureSeal™ supraglottic airway with attached Cuff Pilot ™ is indicated for use in achieving and maintaining control of the airway during routine anesthetic procedures on fasted patients and emergency procedures using either spontaneous or Positive Pressure Ventilation (PPV).

  • An alternative to a face mask.
  • An airway device in routine anesthesia procedures.
  • Securing the immediate airway in anticipated or unexpected difficult airway situations.
  • Use in elective surgical procedures where tracheal intubation is not necessary.
  • Establishing an immediate, clear airway during cardiopulmonary resuscitation (CPR) in the profoundly unconscious patient requiring artificial ventilation when tracheal intubation is not possible.

Patient Population: Patients who need an artificial airway, pediatric to adult.

Environments of Use: To be used under medical supervision in hospital (EMS), extended care facilities and outpatient clinics, where a patient needs an artificial airway. It may also be used in MRI suites and is considered MRI Safe.

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

BSK, CAE

Device Description

Cuff Pilot™:
The Cuff Pilot™ is a simple device which allows the user to monitor the cuff pressure of supraglottic airways. It has been designed to display pressure ranges via color coded zones. The Cuff Pilot™ is designed with an internal bellows, is compressed as pressure increases and expands when intra-cuff pressure is less. There is an O-ring indicator that is on the bellows and this indicates the status of pressure within the define color coded pressure zones.

SureSeal™ with Cuff Pilot™:
The SureSeal™ supraglottic airway is very similar in design, performance, indications for use, technology of operation, and materials to our LMA airways. It will have the Cuff Pilot™ attached and is considered MR Safe.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

supraglottic, airway

Indicated Patient Age Range

pediatric to adult

Intended User / Care Setting

To be used under medical supervision in hospital (EMS), extended care facilities and outpatient clinics. It may also be used in MRI suites.

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)

Cuff Pilot™:

  • Performance Testing: Accuracy across the pressure range, Repeatability, Tested for accuracy after exposure to high and low temperatures, Accuracy within the pressure zone ranges, Subjected samples to aging and exposure to cold and hot temperatures, Drop / Shipping test.
  • Key Results: The performance is similar to the predicate. EasyCuff™ (K102704). The performance specifications of the Cuff Pilot™ and the predicate are substantially equivalent.

SureSeal™ with Cuff Pilot™:

  • Performance Testing: Age / shelf-life, hot and cold temperatures and drop / shipping testing.
  • Key Results: The SureSeal™ met it specifications after these tests.

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

Cuff Pilot™:

  • Pressure Range of the device: 0 to 80 cm H₂O
  • Accuracy: +/- 5 cmH₂O up to 80 cmH₂O
  • Shelf-life: 3 years

SureSeal™ with Cuff Pilot™:

  • Shelf-life: 3 years

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.

Easy Cuff – K102704, LMA™ Classic – K130304

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

§ 868.5750 Inflatable tracheal tube cuff.

(a)
Identification. An inflatable tracheal tube cuff is a device used to provide an airtight seal between a tracheal tube and a patient's trachea.(b)
Classification. Class II (performance standards).

0

Image /page/0/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" arranged around the perimeter. Inside the circle is an abstract symbol that resembles a stylized human figure in profile, with three faces overlapping each other.

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

May 8, 2015

Teleflex Medical c/o Mr. Paul Dryden Consultant 3015 Carrington Mill Blvd. Morrisville, NC 27560

Re: K142103

Trade/Device Name: Cuff Pilot™, SureSeal™ with Cuff Pilot™ Regulation Number: 21 CFR 868.5750 Regulation Name: Inflatable Tracheal Tube Cuff Regulatory Class: II Product Code: BSK, CAE Dated: April 27, 2015 Received: April 28, 2015

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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

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.

1

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 contact the Division of Small Manufacturers, International and Consumer Assistance at its tollfree number (800) 638-2041 or (301) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevices/Resourcesfor You/Industry/default.htm. 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/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Tina
Kiang -S

for Erin I. Keith, M.S. Director Division of Anesthesiology, General Hospital, Respiratory, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known)

K142103

Device Name

Cuff Pilot™

Indications for Use (Describe)

To monitor intra-cuff pressures of supraglottic airways.

Patient Population:

Patients who have an artificial airway and for which the user would like to monitor cuff pressure, pediatric to adult.

Environments of Use:

To be used under medical supervision in hospital (EMS), extended care facilities and outpatient clinics, where a patient may have an artificial airway. It may also be used in MRI suites when attached to airways that are MR conditional or MR Safe.

Type of Use (Select one or both, as applicable)
-------------------------------------------------

XX Prescription Use (Part 21 CFR 801 Subpart D)

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

CONTINUE ON A SEPARATE PAGE IF NEEDED.

This section applies only to requirements of the Paperwork Reduction Act of 1995.

DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to:

Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff(@fda.hhs.gov

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

3

Expiration Date: January 31, 2017

See PRA Statement below.

DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

510(k) Number (if known)

K142103

Device Name

SureSeal™ with Cuff Pilot™

Indications for Use (Describe)

The SureSeal™ supraglottic airway with attached Cuff Pilot ™ is indicated for use in achieving and maintaining control of the airway during routine anesthetic procedures on fasted patients and emergency procedures using either spontaneous or Positive Pressure Ventilation (PPV).

  • An alternative to a face mask.
  • . An airway device in routine anesthesia procedures.
  • Securing the immediate airway in anticipated or unexpected difficult airway situations.
  • Use in elective surgical procedures where tracheal intubation is not necessary.
  • Establishing an immediate, clear airway during cardiopulmonary resuscitation (CPR) in the profoundly ● unconscious patient requiring artificial ventilation when tracheal intubation is not possible.

Patient Population: Patients who need an artificial airway, pediatric to adult.

Environments of Use:

To be used under medical supervision in hospital (EMS), extended care facilities and outpatient clinics, where a patient needs an artificial airway. It may also be used in MRI suites and is considered MRI Safe.

Type of Use (Select one or both, as applicable)

XX Prescription Use (Part 21 CFR 801 Subpart D)

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

CONTINUE ON A SEPARATE PAGE IF NEEDED.

This section applies only to requirements of the Paperwork Reduction Act of 1995.

DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to:

Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff(@fda.hhs.gov

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

4

510(k) Summary Page 1 of 7 8-May-15

| Teleflex Medical
3015 Carrington Mill Blvd
Morrisville, NC 27560 | Telephone: 919-361-3934
Fax: 919-433-4996 |
|------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------|
| Official Contact: | Justin Lovelace
Regulatory Affairs Specialist |
| Proprietary or Trade Name: | Cuff Pilot™ |
| Common/Usual Name: | Cuff Pilot™
SureSeal™ with Cuff Pilot™ |
| Classification Name: | Cuff, tracheal tube, inflatable (accessory
BSK – 21 CFR 868.5750, Class II
Airway, oropharyngeal
CAE – 21 CFR 868.5110, Class I |
| Predicate Devices: | Easy Cuff – K102704
LMA™ Classic – K130304 |

Device Description:

The Cuff Pilot™ is a simple device which allows the user to monitor the cuff pressure of supraglottic airways. It has been designed to display pressure ranges via color coded zones. The Cuff Pilot™ is designed with an internal bellows, is compressed as pressure increases and expands when intra-cuff pressure is less. There is an O-ring indicator that is on the bellows and this indicates the status of pressure within the define color coded pressure zones.

The SureSeal™ supraglottic airway is very similar in design, performance, indications for use, technology of operation, and materials to our LMA airways. It will have the Cuff Pilot™ attached and is considered MR Safe.

Indications for Use - Cuff Pilot™

To monitor intra-cuff pressures of supraglottic airways.

Patient Population: Patients who have an artificial airway and for which the user would like to monitor cuff pressure, pediatric to adult.

Environments of Use: To be used under medical supervision in hospitals, pre-hospital (EMS), extended care facilities and outpatient clinics, where a patient may have an artificial airway. It may also be used in MRI suites when attached to airways that are MR conditional or MR Safe.

Indications for Use - SureSeal™ with Cuff Pilot™

The SureSeal™ supraglottic airway with attached Cuff Pilot™ is indicated for use in achieving and

5

510(k) Summary Page 2 of 7 8-May-15

maintaining control of the airway during routine anesthetic procedures on fasted patients and emergency procedures using either spontaneous or Positive Pressure Ventilation (PPV).

  • An alternative to a face mask. .
  • An airway device in routine anesthesia procedures.
  • Securing the immediate airway in anticipated or unexpected difficult airway situations. .
  • . Use in elective surgical procedures where tracheal intubation is not necessary.
  • . Establishing an immediate, clear airway during cardiopulmonary resuscitation (CPR) in the profoundly unconscious patient requiring artificial ventilation when tracheal intubation is not possible.

Patient Population: Patients who need an artificial airway

Environments of Use: To be used under medical supervision in hospitals, pre-hospital (EMS), extended care facilities and outpatient clinics, where a patient needs an artificial airway. It may also be used in MRI suites and is considered MRI Safe.

| Attribute | Predicate
Easy Cuff (K102704) | Proposed Device
Cuff Pilot™ |
|---------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Indications for Use | To inflate cuffs and to measure and
monitor intra-cuff pressures of
endotracheal, supraglottic airways, or
tracheostomy tubes. | To monitor intra-cuff pressures of
supraglottic airways. |
| Environments of use | To be used under medical supervision in
hospitals, pre-hospital (EMS), extended
care facilities and outpatient clinics,
where a patient may be intubated. | To be used under medical supervision in
hospitals, pre-hospital (EMS), extended care
facilities and outpatient clinics, where a
patient may have an artificial airway. It may
also be used in MRI suites when attached to
airways that are MR conditional or MR Safe. |
| Patient population | Intubated patients | Patients who have an artificial airway and for
which the user would like to monitor cuff
pressure, pediatric to adult. |
| Technology | Bellows that move with changes in
pressure
Expands with higher pressures
Contracts with lower pressures | Bellows that move with changes in pressure
Contracts with higher pressures
Expands with lower pressures |
| Method of inflating cuff | Use the integrated syringe
Manual | Use an independent syringe
(normal practice)
Manual |
| Attaches to the Cuff Inflation
Pilot | Yes via a luer fitting | Yes via a luer fitting
May be permanently attached to an airway's
cuff inflation line |
| Types of airways to which it
can be used | Supraglottic airway
Endotracheal tube
Tracheostomy tube | Supraglottic airway |
| Single patient, disposable | Yes | Yes |
| Pressure Range of the device | 0 to 60 cm H₂O | 0 to 80 cm H₂O |

6

510(k) Summary Page 3 of 7 8-May-15

| Attribute | Predicate
Easy Cuff (K102704) | Proposed Device
Cuff Pilot™ |
|---------------------------|---------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------|
| Detection of "good range" | Color coded and a scale | Color coded zones |
| Packaged | Non-sterile | Non-sterile
Sterile |
| Accuracy | +/- 1 cmH2O up to 30 cmH2O
+/- 2 cmH2O at 40 cmH2O
+/- 5 cmH2O at 60 cmH2O | +/- 5 cmH2O up to 80 cmH2O |
| MRI Use | Not labeled | MR Safe based upon the lack of
materials which contain metal or are
magnetic per ASTM F2052-06,
rationale |
| Shelf-life | Not provided | 3 years |
| Performance Testing | Accuracy across the pressure range
Repeatability
Tested for accuracy after exposure to high
and low temperatures | Accuracy within the pressure zone
ranges
Repeatability
Subjected samples to aging and
exposure to cold and hot temperatures |
| Drop test | | Drop / Shipping test |

Substantial Equivalence Discussion:

The Cuff Pilot™ is viewed as substantially equivalent to the predicate devices because:

Indications -

The Cuff Pilot™ is intended to monitor the intra-cuff pressure of Supraglottic airways. Discussion - The predicate, EasyCuff™ (K102704) is designed to inflate the cuff instead of requiring a separate syringe, which is the normal practice. This difference does not raise any new safety or effectiveness concerns, thus the proposed device is considered substantially equivalent. The proposed Cuff Pilot™ is intended to monitor changes in cuff pressure and display the pressure within a range or zone. Actual pressure will be set or checked with a separate cuff pressure gauge.

Environment of Use -

The Cuff Pilot™ has the same environment of use as the predicate plus MRI suites. Discussion - The Cuff Pilot™ has no magnetic materials and thus can be considered MR Safe. It can be used with any artificial airway that is deemed to be MR Conditional or MR Safe. The predicate is likely MR Conditional but it was not an indication in the original submission. This difference does not raise any new safety or effectiveness concerns that have not been addressed in the rationale and thus the proposed device can be considered substantially equivalent.

Patient Population -

The Cuff Pilot™ has the same patient population as the predicate.

Discussion - Since patients who have a supraglottic airway are not technically considered "intubated"; the predicate, EasyCuff™ (K102704) term in not correct. This is no different than the predicate and thus the proposed device is considered substantially equivalent.

7

510(k) Summary Page 4 of 7 8-May-15

Technology -

The Cuff Pilot™ uses a bellows which moves in relationship to the intra-cuff pressure. As pressures increases the bellows collapses.

Discussion - The use of a bellows which moves in relationship to the intra-cuff pressure is identical to the predicate EasyCuff™ (K102704). The only differences is that for the proposed device the bellows compresses with increasing pressure while the predicate EasyCuff™ bellows expands with increasing pressure. Each device has color coded zones, which represent pressures, which informs the user of the relative cuff pressure within the zone. Any difference does not raise any new safety or effectiveness concerns, thus the proposed device is considered substantially equivalent.

Summary of Non-clinical Testing

The following is a summary of non-clinical bench testing.

Materials -

There are no materials of the Cuff Pilot™ in contact with the patient or in the gas pathway. Discussion - We have performed ISO 10993-1 cytotoxicity testing on the Cuff Pilot™. The results were non-reactive.

Performance -

We have performed a number of tests to demonstrate the accuracy and repeatability of the measured pressure for the Cuff Pilot™. The performance is similar to the predicate. EasyCuff™ (K102704).

The tests performed are:

  • Real-time age testing - 3 years
  • Accuracy across the pressure zone / range
  • Repeatability
  • Subjected samples to aging and exposure to cold and hot temperatures ●
  • Drop / Shipping test ●

Discussion - The performance specifications of the Cuff Pilot™ and the predicate are substantially equivalent.

Substantial Equivalence Conclusion -

The sponsor has demonstrated through performance testing, design and features, and non-clinical testing that the proposed device and predicate have been found to be substantially equivalent.

SureSeal™ with Cuff Pilot™

SureSeal™ is only offered with the Cuff Pilot™ is standard Supraglottic airway similar in design and function to the LMA Classic™. It is considered a Class 1 exempt device but we are seeking to have the Cuff Pilot™ attached as well as seeking MR Safe environment of use.

8

510(k) Summary

AttributePredicateProposed Device
LMA Classic™ (K130304)SureSeal™ with Cuff Pilot™
ClassificationProcode -CAE - airway, oropharyngeal
CFR – 868.5110
Class 1 - exemptProcode -CAE – airway, oropharyngeal
CFR – 868.5110
Class 1 - exempt
Indications for UseLMA Classic™ is indicated for use in
achieving and maintaining control of the
airway during routine anesthetic procedures
on fasted patients and emergency procedures
using either spontaneous or Positive Pressure
Ventilation (PPV).
• An alternative to a face mask.
• An airway device in routine anesthesia
procedures.
• Securing the immediate airway in
anticipated or unexpected difficult airway
situations.
• Use in elective surgical procedures where
tracheal intubation is not necessary.
• Establishing an immediate, clear airway
during cardiopulmonary resuscitation (CPR)
in the profoundly unconscious patient
requiring artificial ventilation when tracheal
intubation is not possible.The SureSeal™ supraglottic airway is
indicated for use in achieving and
maintaining control of the airway during
routine anesthetic procedures on fasted
patients and emergency procedures using
either spontaneous or Positive Pressure
Ventilation (PPV).
• An alternative to a face mask.
• An airway device in routine anesthesia
procedures.
• Securing the immediate airway in
anticipated or unexpected difficult airway
situations.
• Use in elective surgical procedures where
tracheal intubation is not necessary.
• Establishing an immediate, clear airway
during cardiopulmonary resuscitation (CPR)
in the profoundly unconscious patient
requiring artificial ventilation when tracheal
intubation is not possible.
Patient populationPatients who need an artificial airwayPatients who need an artificial airway
Environments of useTo be used under medical supervision in
hospitals, pre-hospital (EMS), extended care
facilities and outpatient clinics, where a
patient needs an artificial airway. It may also
be used in MR suites as MR Conditional.To be used under medical supervision in
hospitals, pre-hospital (EMS), extended care
facilities and outpatient clinics, where a
patient needs an artificial airway. It may
also be used in MRI suites when attached to
airways that are MR Safe.
TechnologyInflatable cuff and tube that rest above the
glottis openingInflatable cuff and tube that rest above the
glottis opening
Method of inflating cuffUse integrated pilot check valve with a
separate syringe. ManualUsed with Cuff Pilot™ and
a separate syringe. Manual
Available in sizesSizes 1 to 6Sizes 1 to 6
Single patient,
disposableYesYes
AttributePredicateProposed Device
LMA ClassicTM (K130304)SureSealTM with Cuff PilotTM
MRI UseMR ConditionalMR Safe based upon the lack of materials
which contain metal or are magnetic per
ASTM F2052-06, rationale
BiocompatibilitySurface and Externally communicating
contact
(indirect gas pathway)
Tissue / Mucosa contact
Limited durationSurface and Externally communicating
contact
(indirect gas pathway)
Tissue / Mucosa contact
Limited duration
Shelf-life3 years3 years
Performance TestingAge
Hot / Cold temperature
Drop / shipping

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510(k) Summary Page 6 of 7 8-May-15

Substantial Equivalence Discussion:

The SureSeal™ is viewed as substantially equivalent to the predicate device because:

Indications -

The SureSeal™ is indicated for use in achieving and maintaining control of the airway during routine anesthetic procedures on fasted patients and emergency procedures using either spontaneous or Positive Pressure Ventilation (PPV).

Discussion - The predicate, LMA Classic™ (K130304) is also designed to achieve and maintain and airway. There are no differences, thus there are no new safety or effectiveness concerns raised, thus the proposed device is considered substantially equivalent.

Environment of Use -

The SureSeal™ has the same environment of use as the predicate including use in MRI suites. Discussion - The SureSeal™ and the Cuff Pilot™ have no magnetic materials and thus can be considered MR Safe. The predicate is MR Conditional because the inflation check valve does contain magnetic materials. This difference does not raise any new safety or effectiveness concerns that have not been addressed in the rationale and thus the proposed device can be considered substantially equivalent.

Patient Population -

The SureSeal™ has the same patient population as the predicate.

Discussion - There are no differences between the proposed device, thus it can be considered substantially equivalent.

Technology -

The SureSeal™M employs the same technology and principle of operation as the predicate. Discussion - The design and technology is similar between the devices and there are no differences which would raise any new safety or effectiveness concerns, thus the proposed device is considered substantially equivalent.

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510(k) Summary Page 7 of 7 8-May-15

Materials -

The materials are similar between the devices.

Discussion - We have performed ISO 10993-1 testing for the materials for the SureSeal™. Based upon ISO 10993-1 and G95-1 the SureSeal™ would be considered as:

  • . Surface Contact and Externally communicating (indirect gas pathway)
  • Tissue / Mucosa contact
  • Limited duration (