K Number
K993772
Device Name
X-COATED CAPIOX SX18 AND SX25 HOLLOW FIBER OXYGENATOR WITH/ WITHOUT DETACHABLE HARDSHELL RESERVOIR
Date Cleared
2000-06-05

(210 days)

Product Code
Regulation Number
870.4350
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
X-Coated CAPIOX® SX25 and SX18 Hollow Fiber Oxygenators The with/without Detachable Hardshell Reservoirs are used to exchange gases with without and a gaseous environment to satisfy the gas exchange needs of a patient during cardiopulmonary bypass surgery for periods up to 6 hours. The integral heat exchanger is used to warm or cool blood or perfusion fluid as it flows through the device. (detachable) hardshell reservoir is used to store blood during The extracorporeal circulation from both the venous line and the cardiotomy line. The reservoir contains a venous section that is comprised of a filter and defoamer to facilitate air bubble removal. The cardiotomy section of the reservoir contains a filter to remove particulate matter and a defoamer to facilitate air bubble removal. The X-Coat is a polymer coating that is applied to blood contacting surfaces of the oxygenator to reduce the adhesion of platelets to the surfaces of the device.
Device Description
X-Coated CAPIOX® SX25 and SX18 Hollow Fiber Oxygenators with/without Detachable Hardshell Reservoirs. The device is used to exchange gases with a gaseous environment to satisfy the gas exchange needs of a patient during cardiopulmonary bypass surgery. It includes an integral heat exchanger to warm or cool blood or perfusion fluid. The detachable hardshell reservoir stores blood and contains filters and defoamers to remove air bubbles and particulate matter. The device has an X-Coat polymer coating on blood contacting surfaces to reduce platelet adhesion.
More Information

Not Found

K/DEN: Not Found

No
The summary describes a mechanical device for cardiopulmonary bypass surgery with no mention of AI or ML capabilities.

Yes
Explanation: The device is used to exchange gases and regulate blood temperature during cardiopulmonary bypass surgery, directly treating or supporting a patient's physiological function.

No

Explanation: The device description states its purpose is to "exchange gases" and "warm or cool blood or perfusion fluid" during cardiopulmonary bypass surgery. These are therapeutic functions, not diagnostic ones. Diagnostic devices are used to identify or monitor a medical condition, which this device does not do.

No

The device description clearly outlines physical components like hollow fibers, a heat exchanger, a hardshell reservoir, filters, defoamers, and a polymer coating, indicating it is a hardware device used in cardiopulmonary bypass surgery.

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

Here's why:

  • IVD Definition: In Vitro Diagnostics are devices intended for use in the examination of specimens derived from the human body solely or principally for the purpose of providing information concerning a physiological state, state of health, or disease or congenital abnormality. This examination is performed outside of the living body (in vitro).
  • Device Function: The description clearly states the device is used for "exchang[ing] gases... to satisfy the gas exchange needs of a patient during cardiopulmonary bypass surgery." This is a direct intervention on the patient's blood within the body's circulatory system during surgery. It's a life support device, not a diagnostic test performed on a sample.
  • Lack of Diagnostic Purpose: The intended use and device description focus on gas exchange, temperature regulation, and blood handling during surgery. There is no mention of analyzing blood or other bodily fluids to provide diagnostic information.

Therefore, this device falls under the category of a therapeutic or life support device used during surgery, not an In Vitro Diagnostic.

N/A

Intended Use / Indications for Use

X-Coated CAPIOX® SX25 and SX18 Hollow Fiber Oxygenators The with/without Detachable Hardshell Reservoirs are used to exchange gases with without and a gaseous environment to satisfy the gas exchange needs of a patient during cardiopulmonary bypass surgery for periods up to 6 hours.

The integral heat exchanger is used to warm or cool blood or perfusion fluid as it flows through the device.

(detachable) hardshell reservoir is used to store blood during The extracorporeal circulation from both the venous line and the cardiotomy line. The reservoir contains a venous section that is comprised of a filter and defoamer to facilitate air bubble removal. The cardiotomy section of the reservoir contains a filter to remove particulate matter and a defoamer to facilitate air bubble removal.

The X-Coat is a polymer coating that is applied to blood contacting surfaces of the oxygenator to reduce the adhesion of platelets to the surfaces of the device.

Product codes

DTZ

Device Description

Not Found

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

Not Found

Intended User / Care Setting

Not Found

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)

Not Found

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

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

Kb3772

SUMMARY OF INFORMATION

GARDING SAFETY AND EFFECTIVENESS ISSUE
FOR OXYGENATORS

re references were obtained through a seath of the Medine database (1988 – October, 1999), and articles inhouse. Other
were Medical Device Reports/Diogenese database (1985-

Vote: A summary of the methods used to address these issues is presented on pp.

I
E
1ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ
AB.
ET
ItemPossible CauseReference1
Effect on Blood ComponentsContact with foreign surfaces and air, turbulent blood
flow/flow pattern, temperature, surgical procedures2,
excessive gas flow1,2,3,4,5,6,7,8,9,10,
11,12,22, 29
Decrease/Poor Gas ExchangePlasma leakage/plasma breakthrough, improper
technique (failure to connect gas line, failure to increase
O2 during rewarming, etc.), device design, channeling,
water condensation, thrombus in blood phase, improper
storage13,31 MDR database
complaint file
Effects on coagulation systemContact with foreign surfaces, inadequate
anticoagulation4, MDR database
ItemPossible CauseReference3
BiocompatibilityContact with foreign surfaces, manner of
oxygenation/vigourous bubbling, aggregation of
immunoglobulins, protamine-heparin complex, protein
denaturation at blood-polymer interface, constituents of
priming solution/wetting agent, anesthesia, tissue
damage4,5,6,7,8,9,12,14,24,
25,26,27,28,30,32
Microemboli15,16,17,18
GaseousSuction system, inadequate priming/debubbling,
overocclusion of the pumphead setting, manner of
oxygenation/vigorous bubbling, technique
Blood component aggregatesContained in cardiotomy/suction blood and in donor
blood, activation of platelets and/or leukocytes due to
contacting foreign surfaces, technique
Debris, particulatesManufacturing process, improper technique, other
devices/equipment used in cardiopulmonary bypass,
antifoam agents
Absorption/uptake of medicationsAbsorption by some materials19,20,21,23
ItemPossible CauseReference4
Foaming/defoamer failureInadequate defoaming agent, using flow rates greater than maximum rated flow rateMDR database, complaint file
Macro Air BolusImproper technique (e.g. clamping gas outlet line, loose connections)
(See also microemboli above)MDR database
Leaks: water, blood, gas, priming solutionMishandling/damage during shipment, improper technique (e.g. overpressurizing), manufacturing defectMDR database, complaint file
Broken/missing parts, packaging defects/sterility barrier brokenDamage during handling or shipping, manufacturing defectMDR database, complaint file
Poor heat exchangeHeater/cooler malfunction, design
Clotting, poor designMDR database
Miscellaneous infrequent items: e.g. venous resistance, high pressure dropMDR database, complaint file
ContaminationDamage during shment, techniqueobservation
Failure of measuring temperatureUse of inappropriate thermistorobservation

s refer to references listed in the Bibliography following this Table.
Inon leukocyte counts are also seen in other types of extracorporal circulation such as hemodialysis, l

1

TABLE 1 (cont.)

3 Numbers refer to references listed in the Bibliography following this Table

!!

2

TABLE 1 (cont.)

4 Numbers refer to references listed in the Bibliography following this Table

・・

3

SUMMARY OF INFORMATION
GARDING SAFETY AND EFFECTIVENESS ISSUE
FOR DEFOAMERS

terature references were obtained the Medine database (1988 – October, 1999), and articles inbouse. Other
urces were Medical Device Reports/Diogenes database (1985-Consultat

Note: A summary of the methods used to address these is presented on pp.

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4
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1
ItemPossible CauseReferences
Visible foamingPoor performance,
inadequate defoaming agentMDR Database, complaint file
Structural defectManufacturing defect,
damage during shipment or user handlingMDR Database, complaint file
Increase in pressure gradient, slow
breakthroughInadequate patient anticoagulation, clots/blocking/poor
performanceMDR Database

umbers refer to references listed in the Bibliography following this

4

Image /page/4/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 three human profiles facing to the right, stacked on top of each other.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JUN = 5 2000

Mr. Garry A. Courtney Requlatory Affairs Terumo Medical Corporation 125 Blue Ball Road Elkton, MD 21921

K993772 Re: Trade Name: X-Coated Capiox SX18 and SX25 Hollow Fiber Oxygenators with/without Detachable Hardshell Resevoirs. Regulatory Class: III (Three) Product Code: DTZ Dated: March 4, 2000 March 7, 2000 Received:

Dear Mr. Courtney:

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 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). 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 (Premarket Approval), 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 895. A substantially equivalent determination assumes compliance with the Current Good Manufacturing Practice requirements, as set forth in the Quality System Regulation (QS) for Medical Devices: General regulation (21 CFR Part 820) and that, through periodic QS inspections, the Food and Drug Administration (FDA) will verify such assumptions. Failure to comply with the GMP regulation may result in requlatory action. In addition, 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.

5

Page 2 - Garry A. Courtney

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 our 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" (21CFR 807.97). Other general 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.gov/cdrh/dsma/dsmamain.html".

Singerely yours,

Sincerely yours,

James E. Dillard III

Director Division of Cardiovascular and Respiratory Devices Office of Device Evaluation Center for Devices and Radiological Health

6

K 993772/51

510(k) Number (if known):

| Device Name: | X-Coated CAPIOX® SX25 and SX18 Hollow Fiber Oxygenators
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ |
|--------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| | and the control controlled of the consisted on the comments of the comments of the comments of the comments of the comments of the comments of the comments of the comments of
with/without Detachable Hardshell Reservoirs.
11, NA SECRECAMENT A CONSULTION CONSULTION CONSULTION CONSULTION CONSULTION CONSULTION CONSULTION CONSULTION CONSULTION CONSULTION CONSULTION CONSULTION CONSULTION CONSULTION
I |

Indications For Use:

Intended Use Described In The 510(k):

X-Coated CAPIOX® SX25 and SX18 Hollow Fiber Oxygenators The with/without Detachable Hardshell Reservoirs are used to exchange gases with without and a gaseous environment to satisfy the gas exchange needs of a patient during cardiopulmonary bypass surgery for periods up to 6 hours.

The integral heat exchanger is used to warm or cool blood or perfusion fluid as it flows through the device.

(detachable) hardshell reservoir is used to store blood during The extracorporeal circulation from both the venous line and the cardiotomy line. The reservoir contains a venous section that is comprised of a filter and defoamer to facilitate air bubble removal. The cardiotomy section of the reservoir contains a filter to remove particulate matter and a defoamer to facilitate air bubble removal.

The X-Coat is a polymer coating that is applied to blood contacting surfaces of the oxygenator to reduce the adhesion of platelets to the surfaces of the device.

Harriet Caudrix

Regulatory Affairs Terumo Medical Corporation

(PLEASE DO NOT WRITE BELOW THIS LINE – CONTINUE ON ANOTHER PAGE IF NEEDED)

OR

Concurrence of CDRH, Office of Device Evaluation (ODE)
(Division Sign-Off)
sion of Cardiovascular, Respiratory, Neurological Devices
510(k) Number K993772

Prescription Use ನ Over-The-Counter Use

(Per 21 CFR 801.109)