GE DATEX-OHMEDA ENGSTROM CARESTATION

K050597 · Datex-Ohmeda, Inc. · CBK · Mar 25, 2005 · Anesthesiology

Device Facts

• Record ID: K050597
• Device Name: GE DATEX-OHMEDA ENGSTROM CARESTATION
• Applicant: Datex-Ohmeda, Inc.
• Product Code: CBK · Anesthesiology
• Decision Date: Mar 25, 2005
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 868.5895
• Device Class: Class 2
• Attributes: Therapeutic, Pediatric

Intended Use

The GE Datex-Ohmeda Engstrom Carestation is designed to provide mechanical ventilation for adults and pediatrics weighing 5kg and above having degrees of pulmonary impairment varying from minor to severe. The modes of ventilation are available include: - Volume Controlled (VCV) . - Pressure Controlled (PCV) ● - Pressure Controlled, Volume Guaranteed (PCV-VG) - Synchronized Intermittent Mandatory Ventilation, Volume Controlled (SIMV-VC) . - Synchronized Intermittent Mandatory Ventilation, Pressure Controlled (SIMV-PC) ◆ - Bi-level Airway Pressure Ventilation . - Constant Positive Airway Pressure/Pressure Support Ventilation (CPAP/PSV) . - Apnea backup (active in Bi-level and CPAP/PSV) . The GE Datex-Ohmeda Engstrom Carestation is a microprocessor based, electronically controlled, pneumatically driven ventilator that includes integrated FiO2, airway pressure, spirometry and volume monitoring and an Aerogen Aeroneb Pro nebulzier. Options include integrated respiratory gas monitoring capabilities via various Datex-Ohmeda patient monitoring modules listed in the product labeling and an integrated air compressor. The system is designed for facility use, including within-facility transport, and should only be used under the orders of a clinician.

Device Story

Microprocessor-based, electronically controlled, pneumatically driven critical care ventilator; provides mechanical ventilation for adults/pediatrics (≥5kg). Inputs: airway pressure, FiO2, spirometry, volume monitoring; optional respiratory gas monitoring modules. Outputs: controlled ventilation modes (VCV, PCV, PCV-VG, SIMV-VC, SIMV-PC, Bi-level, CPAP/PSV) and apnea backup. Used in clinical facilities/within-facility transport by clinicians. System integrates patient monitoring, ventilation, and information management. Optional integrated air compressor provides breathable gas supply. Healthcare providers use system display for settings, monitoring, and nebulization control; output informs clinical respiratory management and patient support.

Clinical Evidence

Bench testing only. Compliance with voluntary standards including UL 2601, ASTM F1100, EN/IEC 60601-1, EN/IEC 60601-1-2, EN 475, and EN/IEC 60601-2-12.

Technological Characteristics

Microprocessor-based, electronically controlled, pneumatically driven. Integrated FiO2, airway pressure, spirometry, volume monitoring. Options: respiratory gas monitoring modules, air compressor. Standards: UL 2601, ASTM F1100, EN/IEC 60601-1, EN/IEC 60601-1-2, EN 475, EN 980, EN/IEC 60601-2-12.

Indications for Use

Indicated for mechanical ventilation of adult and pediatric patients (≥5kg) with pulmonary impairment ranging from minor to severe. Used in clinical facilities under clinician orders.

Regulatory Classification

Identification

A continuous ventilator (respirator) is a device intended to mechanically control or assist patient breathing by delivering a predetermined percentage of oxygen in the breathing gas. Adult, pediatric, and neonatal ventilators are included in this generic type of device.

Predicate Devices

• GE Datex-Ohmeda Engstrom Carestation (K041775)
• Siemens Mini C Compressor (K023354)

Reference Devices

• Datex-Ohmeda M-Gas Module (K001814)
• Mini-CO2 Module (K023454)
• Aerogen Aeroneb Pro Nebulizer (K021175)

Submission Summary (Full Text)

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MAR 2 5 2005

K050597

| Date: | March 7th, 2005 |
|-----------------|--------------------------------------------------------------------------------------------------------|
| Subject: | 510(k) Summary of Safety and Effectiveness Information<br>for the GE Datex-Ohmeda Engstrom Carestation |
| Proprietary: | GE Datex-Ohmeda Engstrom Carestation |
| Common: | Ventilator, Continuous |
| Classification: | Anesthesiology, 73 CBK, 21 CFR 868.5895 |

The 510(k) summary of safety and effectiveness information is being submitted in accordance with the requirements of SMDA 1990 and 1992.

The GE Datex-Ohmeda Engstrom Carestation is substantially equivalent to the following currently marketed device:

GE Datex-Ohmeda Engstrom Carestation- Class II - 21CFR868.5895, which has been the subject of a cleared 510(k) with FDA log number K041775.

Siemens Mini C Compressor - Class I - 21CFR 868.6250, which has been the subject of a cleared 510(k) with FDK log number K023354

The Engström Ventilator (EV) is a flexible, adaptable, and intuitive critical care ventilator. A wide selection of performance options gives the user full control of the system configuration. The Engström Carestation is a complete system featuring patient monitoring, patient vertilation, and the capability of interfacing with central information management systems.

The GE Datex-Ohmeda Engstrom Carestation is designed to provide mechanical ventilation for adults and pediatrics weighing 5kg and above having degrees of pulmonary impairment varying from minor to severe. The modes of ventilation are available include:

- Volume Controlled (VCV) .
- Pressure Controlled (PCV) .
- Pressure Controlled, Volume Guaranteed (PCV-VG) .
- Synchronized Intermittent Mandatory Ventilation, Volume Controlled (SIMV-VC) .
- Synchronized Intermittent Mandatory Ventilation, Pressure Controlled (SIMV-PC) ◆
- . Bi-level Airway Pressure Ventilation
- Constant Positive Airway Pressure/Pressure Support Ventilation (CPAP/PSV) .
- Apnea backup (active in Bi-level and CPAP/PSV) ◆

The GE Datex-Ohmeda Engstrom Carestation is a microprocessor based, electronically controlled, pneumatically driven ventilator that includes integrated FiO2, airway pressure, spirometry and volume monitoring and an Aerogen Aeroneb Pro nebulzier. Options include integrated respiratory gas monitoring capabilities via various Datex-Ohmeda patient monitoring modules listed in the product labeling and an integrated air compressor.

When supplied as an option, the integrated respiratory gas monitoring is provided via the Datex-Ohmeda M-Gas Module (M-C, M-CO, M-COV, M-COVX, M-CaiO, M-CAiOV, M-CAiOVX,

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(rev 3.2 software and higher) K# 001814) or Mini-CO2 Module (K023454) which are physically (rev 3.2 Soltware and higher) Air of Hill of House electronic power from the Engstrom integrated into the Engstrom Ourostation, Techn's Creation for display on the system display unit.

When supplied as an option, the GE Datex-Ohmeda EV Air Compressor is intended for use as When supplied as an option, the GE Datesthable compressed air supply. The compressor has an accessory to provide a ary, merod, broathable of the compressed gas supply,
no alarm functions. All alarm functions and reactions to failure of the many in install no alam functions. All alam fanetis in the some in K041775. The compressor is installed in the base of the Engstom Carocation of Shering Star is powered from AC mains only. A source of in the base of the venthator our. optional compressor.

The system is designed for facility use, including within-facility transport, and should only be used under the orders of a clinician.

The ventilator consists of three main components: a display, a ventilator unit, and an optional The ventificator consists of three man oon to interface with the system and control settings. The module bay. The display allows nower, nebulization, and pneumatic gas flow to and from the vehinder ann some bay allows the integration of various Datex-Ohmeda patient monitoring modules with the ventilator.

Additional optional accessories include a trolley/cart, compressor, airway modules, module bay, Additional optional water trap mounting brackets, and auxiliary electrical outlets. Support ann, mamamor and watcher is provided via the ventilator display unit. The rne ason internate for Nebulizer (K021175) is provided standard with the unit.

The GE Datex-Ohmeda Engstrom Carestation was designed to comply with the applicable portions of the following voluntary standards;

- 1. UL 2601 General requirements for Medical Electrical Equipment
- 2. ASTM F1100 Particular Requirements for Critical Care Ventilators
- 3. EN/IEC 60601-1: General requirements for Medical Electrical Equipment
- 4. EN/IEC 60601-1-2: 2001 Medical Electrical Equipment Electromagnetic Compatibility
- 5. EN 475 Electrically Generated Alarm Signals
- 6. CGA V-1 ad ISO 5145 Medical Gas Cylinders Threaded Cylinders
- 7. EN 980 Graphical Symbols
- 8. EN/IEC 60601-2-12, Medical Electrical Equipment Critical Care Ventilators

The GE Datex-Ohmeda Engstrom Carestation and the currently marketed device are substantially equivalent in design concepts, technologies and materials. The GE Datex-Ohmeda Engstrom Carestation has been validated through rigorous testing that, in part, supports the compliance of GE Datex-Ohmeda Engstrom Carestation to the standards listed above.

## Contact: Dan Kosednar, RAC

Manager, Regulatory Planning and Submissions

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Image /page/2/Picture/1 description: The image shows the seal for the Department of Health & Human Services - USA. The seal is circular and contains the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. In the center of the seal is an abstract image of an eagle.

Public Health Service

MAR 2 5 2005

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Mr. Dan Kosednar Manager, Regulatory Planning and Submissions Datex-Ohmeda, Incorporated Care Business Area P.O. Box 7550 Madison, Wisconsin 53707

Re: K050597

Trade/Device Name: GE Datex-Ohmeda Engstrom Carestation Regulation Number: 21 CFR 868.5895 Regulation Name: Continuous Ventilator Regulatory Class: II Product Code: CBK Dated: March 8, 2005 Received: March 9, 2005

Dear Mr. Kosednar:

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.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), 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 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

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## Page 2 - Mr. Kosednar

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); 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.

This letter will allow you to begin marketing your device as described in your Section 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 vour device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). 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 [phone] or [phone] or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours,

Sytte Mchui Ord.

Chiu Lin, Ph.D. Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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## Indications for Use

510(k) Number (if known): K050597

## Device Name: GE Datex-Ohmeda Engstrom Carestation

Indications For Use:

The GE Datex-Ohmeda Engstrom Carestation is designed to provide mechanical ventilation for adults and pediatrics weighing 5kg and above having degrees of pulmonary impairment varying from minor to severe. The modes of ventilation are available include:

- Volume Controlled (VCV) .
- Pressure Controlled (PCV) ●
- Pressure Controlled, Volume Guaranteed (PCV-VG)
- Synchronized Intermittent Mandatory Ventilation, Volume Controlled (SIMV-VC) .
- Synchronized Intermittent Mandatory Ventilation, Pressure Controlled (SIMV-PC) ◆
- Bi-level Airway Pressure Ventilation .
- Constant Positive Airway Pressure/Pressure Support Ventilation (CPAP/PSV) .
- Apnea backup (active in Bi-level and CPAP/PSV) .

The GE Datex-Ohmeda Engstrom Carestation is a microprocessor based, electronically controlled, pneumatically driven ventilator that includes integrated FiO2, airway pressure, spirometry and volume monitoring and an Aerogen Aeroneb Pro nebulzier. Options include integrated respiratory gas monitoring capabilities via various Datex-Ohmeda patient monitoring modules listed in the product labeling and an integrated air compressor.

The system is designed for facility use, including within-facility transport, and should only be used under the orders of a clinician.

Prescription Use XXX (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter Use (21 CFR 807 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Page 1 of 1

Ceeu Seleson

Diston Sign Chision of Anesthesiology, General Hospital, Intection Control, Dental Devices

50(k) Number