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510(k) Data Aggregation

    K Number
    K033186
    Manufacturer
    Date Cleared
    2004-04-14

    (196 days)

    Product Code
    Regulation Number
    868.5110
    Reference & Predicate Devices
    Why did this record match?
    Device Name :

    KING LT-D DISPOSABLE OROPHARYNGEAL AIRWAY, MODELS KLT 203, KLT 204 AND KLT 205

    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    The KING LT-D is intended for use in adult patients (in excess of 25 kg) for controlled ventilation during anesthesia for procedures that are short in duration and when the patient is considered to have a low risk of aspiration of stomach contents.

    Device Description

    Each device is constructed of medical grade elastomeric and thermoplastic materials. All fittings conform to ISO 5356-1/1996: Anesthetic and Respiratory Equipment - Conical Connectors; Part 1 Cones and Sockets. The device incorporates the following components or features:

    • . Bi-directional gas flow through a ventilation channel.
    • Inflatable bladders to assist in maintenance of placement and in sealing the . airway from the stomach and from the atmosphere
    • . Indicators for proper placement permanently printed on the tube
    • A rigid plastic connector complying with ISO standards for the 15mm connection . to the patient end of a breathing circuit.
    AI/ML Overview

    This document describes a premarket notification (510(k)) for the KING LT-D Disposable Oropharyngeal Airway, not an AI device. Therefore, many of the requested criteria (e.g., sample sizes for test/training sets, expert ground truth, MRMC studies, standalone performance, software validation) are not applicable.

    The document focuses on demonstrating substantial equivalence to a predicate device for a disposable version of an existing product. The acceptance criteria are related to material properties, design conformity, and intended use, rather than performance metrics of an AI algorithm.

    1. A table of acceptance criteria and the reported device performance

    CharacteristicAcceptance Criteria (based on predicate)KING LT-D Performance (reported)
    Intended Use: Ventilation during anesthesia during procedures of short duration. An oropharyngeal airway is a device inserted through the mouth to provide a patent airway.YesYes
    Design: Tube with two attached, inflatable balloonsYesYes
    Ventilation openings between the balloonsYesYes
    Sterile device indicated for single patient use.No (for predicate)Yes
    ISO Standard 15 mm proximal connector for attachment to breathing circuitYesYes
    Medical grade polymers or approved materials for all components in contact with the anesthesia gas stream.YesYes
    Connected to a Breathing CircuitYesYes
    11.5 mm internal diameterYesYes
    Weight (gm)32.2 (predicate)32.1
    Prescription use only?YesYes
    Inserted blindly?YesYes
    Enters the trachea?NoNo
    Seals the esophagus?YesYes
    Cuffs are inflated with one inflation port?YesYes
    Instructions that patient should have fasted before using the product?YesYes
    Latex free productYesYes
    Product classificationCAF (predicate)CAE
    Materials in conformity with voluntary standards (ISO 5356-1/1996, ASTM F1242-96, EN30993/ISO 10993)Utilized in whole or in partYes (stated in text)
    BiocompatibilityEquivalent to other medical devicesYes (stated in text)
    All verification and validation activities demonstrated that the predetermined acceptance criteria were met.YesYes (stated in text)
    Conformance with design control procedure requirements as specified in 21 CFR 820.30YesYes (stated in text)

    Study Proving Acceptance Criteria:

    The study proving the device meets the acceptance criteria is a premarket notification (510(k)) submission demonstrating substantial equivalence to a legally marketed predicate device (King Systems Corporation KLT Oropharyngeal Airway, 510(k) #K021634).

    The acceptance criteria are primarily met by:

    • Direct comparison of characteristics (e.g., intended use, design, dimensions, materials, sterile status) to the predicate device.
    • Compliance with recognized standards: ISO 5356-1/1996-12-15, ASTM F1242-96, and EN30993/ISO 10993 for biocompatibility.
    • Risk analysis and verification/validation activities: The document states that "the designated individual(s) performed all verification and validation activities and the results of the activities demonstrated that the predetermined acceptance criteria were met."
    • Conformance with design control procedures as per 21 CFR 820.30.

    2. Sample sized used for the test set and the data provenance (e.g. country of origin of the data, retrospective or prospective)

    Not applicable. This is a medical device submission based on substantial equivalence to a predicate, not a study involving a test set of data in the context of an AI/software device. The product is manufactured in Malaysia.

    3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g. radiologist with 10 years of experience)

    Not applicable. This device is not software driven and does not involve AI or the establishment of ground truth by experts in the sense of diagnostic accuracy studies.

    4. Adjudication method (e.g. 2+1, 3+1, none) for the test set

    Not applicable. There is no test set or adjudication process described for this device.

    5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

    Not applicable. This is not an AI-assisted device.

    6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done

    Not applicable. This is not an AI algorithm. The document explicitly states: "This device is not software driven. Software validation and verification is not applicable."

    7. The type of ground truth used (expert consensus, pathology, outcomes data, etc)

    Not applicable in the context of an AI device. For this medical device, the "ground truth" or basis for acceptance is primarily the characteristics and performance of the legally marketed predicate device and compliance with established international and ASTM standards for design, materials, and intended use.

    8. The sample size for the training set

    Not applicable. This is a medical device, not an AI model requiring a training set.

    9. How the ground truth for the training set was established

    Not applicable, as there is no training set for this type of device.

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