K Number
K970991
Device Name
DATEX ENGSTOM MANUAL RESUSCITATOR
Manufacturer
Date Cleared
1997-06-16

(89 days)

Product Code
Regulation Number
868.5915
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
To ventilate the apnoeic patient and to augment ventilation and / or oxygen delivery to the spontaneously breathing patient. For use as an adjunct to artificial respiration and cardiopulmonary resuscitation. Environment of use: Hospital - Emergency Medical Services, Operating Room, during patient transport, Intensive Care Units, where patient assisted ventilation may be administered or required.
Device Description
The Datex Engstrom manual resuscitator is designed for use as an adjunct to artificial respiration and CPR. It can be used to ventilate the apnoeic patient and to augment ventilation and / or oxygen delivery to the spontaneously breathing patient.
More Information

Not Found

No
The summary describes a manual resuscitator and does not mention any AI or ML components or functionalities.

Yes
The device is described as an "adjunct to artificial respiration and cardiopulmonary resuscitation" and is used to ventilate patients, which directly treats a medical condition (apnea or insufficient breathing).

No

The device is a manual resuscitator used to ventilate patients, augmenting respiration and oxygen delivery. Its purpose is to provide respiratory support, not to diagnose medical conditions or analyze patient data for diagnostic purposes.

No

The device description clearly states it is a "manual resuscitator," which is a hardware device used for ventilation. There is no mention of software as the primary component or function.

Based on the provided information, 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.
  • Device Function: The description clearly states the device is a "manual resuscitator" used for "ventilating the apnoeic patient and to augment ventilation and / or oxygen delivery to the spontaneously breathing patient." This is a device that directly interacts with the patient's respiratory system to provide mechanical support.
  • Lack of Sample Analysis: There is no mention of the device analyzing any biological samples from the patient. Its function is purely mechanical ventilation.

Therefore, the Datex Engstrom manual resuscitator falls under the category of a medical device used for respiratory support, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

To ventilate the apnoeic patient and to augment ventilation and / or oxygen delivery to the spontaneously breathing patient. For use as an adjunct to artificial respiration and cardiopulmonary resuscitation.

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

73 BTM

Device Description

The Datex Engstrom manual resuscitator is designed for use as an adjunct to artificial respiration and CPR. It can be used to ventilate the apnoeic patient and to augment ventilation and / or oxygen delivery to the spontaneously breathing patient.

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

Adult, child and infant

Intended User / Care Setting

Emergency medical services, hospital, patient transport, Operating Room (OR), and where assisted ventilation may be required.

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.

K895589, K902062

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

§ 868.5915 Manual emergency ventilator.

(a)
Identification. A manual emergency ventilator is a device, usually incorporating a bag and valve, intended to provide emergency respiratory support by means of a face mask or a tube inserted into a patient's airway.(b)
Classification. Class II (performance standards).

0

K970991

| |

Non-Confidential Summary of Safety and Effectiveness

JUN | 6 iser

page 1 of 3 March 12, 1997

Datex Engstrom AB Box 20109 S-16102 Bromma SWEDEN

Tel - 011-46-8-629-3100Fax - 011-46-8-298418
Official Contact:Arne Salo, President
Proprietary or Trade Name:Datex Engstrom reusable manual resuscitator
Common/Usual Name:Manual resuscitator
Classification Name:Ventilator, Emergency, Manual (Resuscitator)
Device:Datex Engstrom Reusable Manual Resuscitator
Predicate Devices:Hudson RCI - Durable Manual resuscitator - K895589
Hudson RCI - PEEP valves - K902062

Device Description:

The Datex Engstrom manual resuscitator is designed for use as an adjunct to artificial respiration and CPR. It can be used to ventilate the apnoeic patient and to augment ventilation and / or oxygen delivery to the spontaneously breathing patient.

Indicated Use --Provide assisted ventilation
Environment of Use --Emergency medical services, hospital, patient transport,
OperatingRoom (OR), and where assisted ventilation may be required.
Patient population --Adult, child and infant
AttributeDatex-EngstromHudson RCI
Use
Intended for use an adjunct to artificial respiration and CPRYesYes
Can be used to ventilate apnoeic patientsYesYes
Augment ventilation and / or oxygen delivery to spontaneously breathing patientsYesYes
Environment of use - Hospital, OR, anesthesia, PACU, ICU, transport, EMS, where assisted ventilation may be required or neededYesYes
Intended for use by qualified medical and emergency personnel trained in pulmonary ventilation and advanced cardiac life support techniquesYesYes
Indicated for cleaning and reuseYesYes
Indicated population - adult, child, infantYesYes
Design / Theory of Operation
Connects to a Face mask or endotracheal tubeYesYes
Has four major components Rebreathing valve, Silicone bag, Reservoir valve, Oxygen reservoirYesYes
May incorporate a PEEP valveYesYes
Available is three (3) sizesYesYes
Has available oxygen reservoirYesYes
AttributeDatex-EngstromHudson RCI
Design / Theory of Operation
Fits to standard 15 / 22 mm patient
end fittingsYesYes
Offered with standard reusable
face mask - various stylesYesYes
May be taken apart and cleanedYesYes
Cleaning methods - autoclave, EtOYesYes
Materials
Bag and duckbill valve - siliconeYesYes
Patient connector, housing parts
made of PolysulfoneYesYes
Pop-off valve - aluminumYesYes
PEEP valve spring stainless steelYesYes
Face mask - silicone or PVCYesYes
Reservoir bag - PVCYesYes
Performance Standards / Specifications
Patient fittings - 15 / 22 mm
ASTM 1054 / ISO 5356YesYes
Meets all specifications, testing
and requirements of
ASTM 920 / ISO 8382YesYes

Comparison to Predicate Devices:

page 4 of 76

Dates-Eng-Irom AB

Postadress/Postal address Box 2:11:14

Telefon/Telephone Nat 08-629 31 19

lelefax Nat 08-29 84 18

1

Non-Confidential Summary of Safety and Effectiveness

(continued)

page 2 of 3

March 12, 1997

2

Non-Confidential Summary of Safety and Effectiveness

(continued)

page 3 of 3

March 12, 1997

Differences between Other Legally Marketed Predicate Devices

There is no differences between the intended device and the predicate devices which would be significant to patient safety or effectiveness.

Page 6 of 76

3

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JUN 1 6 1997

Mr. Paul Dryden Datex Engstrom AB c/o ProMedic, Inc. 6329 W. Waterview Court McCordsville, Indiana 46055-9501

Re: K970991 Datex-Engstrom Medical Reusable Manual Resuscitator Regulatory Class: II (two) Product Code: 73 BTM Dated: March 13, 1997 Received: March 19, 1997

Dear Mr. Dryden:

We have reviewed your Section 510(k) notification of intent to market the device referenced above and we have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to 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). You may, therefore, market the device, subject to the general controls provisions of the Act. However, you are responsible to determine that the medical devices you use as components in the kit have either been determined as substantially equivalent under the premarket notification process (Section 510(k) of the act), or were legally on the market prior to May 28, 1976, the enactment date of the Medical Device Amendments. Please note: If you purchase your device components in bulk (i.e., unfinished) and further process (e.g., sterilize) you must submit a new 510(k) before including these components in your kit. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, and labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (Premarket Approval) it may be subject to such additional controls. Existing major regulations affecting your device

4

Page 2 - Mr. Paul Dryden

can be found in the Code of Federal Requlations, Title 21, Parts 800 to 895. A substantially equivalent determination assumes compliance with the Good Manufacturing Practice for Medical Devices: General (GMP) requlation (21 CFR Part 820) and that, through periodic GMP inspections, FDA will verify such assumptions. Failure to comply with the GMP regulation may result in regulatory action. In addition, the Food and Druq Administration (FDA) may publish further announcements concerning your device in the Federal Register. Please note: this response to your premarket notification submission does not affect any obligation you might have under sections 531 through 542 of the Act for devices under the Electronic Product Radiation Control provisions, or other Federal Laws or Regulations.

This letter will allow you to begin marketing your device as described in your 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 the labeling regulation (21 CFR Part 801 and additionally 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4648. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 807.97). Other qeneral information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers Assistance at its toll free number (800) 638-2041 or (301) 443-6597, or at its internet address "http://www.fda.qov/cdrh/dsmamain.html".

Sincerely yours,

DA Spyker

Thomas J. Callahan, Ph.D. Director Division of Cardiovascular, Respiratory, and Neurological Devices Office of Device Evaluation Center for Devices and Kadiological Health

Enclosure

5

JUN 1 6 1991

SECTION 3:

INDICATIONS FOR USE

Page 1 of 1

Pursuant to the Notice of February 6, 1996 regarding listing of Indications for Use on a separate sheet, the following is per that request.

510(k) Number:K970991 (To be assigned)
Device Name:Reusable Manual Resuscitator
Intended Use :To ventilate the apnoeic patient and to augment ventilation and / or oxygen delivery to the spontaneously breathing patient. For use as an adjunct to artificial respiration and cardiopulmonary resuscitation.
Environment of use:Hospital - Emergency Medical Services, Operating Room, during patient transport, Intensive Care Units, where patient assisted ventilation may be administered or required.

Concurrence of CDRH, Office of Device Evaluation (ODE)

Christy Harman
(Division Sign-Off)

Division of Cardiovascular, Re a: . Neurological Devices 510(k) Number

Prescription Use
(Per CFR 801.109)

or

Over-the-counter use _

Page 10 of 76