Acumen Hypotension Prediction Index – EV1000 Clinical Platform, Acumen Hypotension Prediction Index – HemoSphere Advanced Monitoring Platform, Acumen Hypotension Prediction Index – HemoSphere Advanced Monitoring Platform - Pressure

K183646 · Edwards Lifeciences, LLC · QAQ · May 21, 2019 · Cardiovascular

Device Facts

• Record ID: K183646
• Device Name: Acumen Hypotension Prediction Index – EV1000 Clinical Platform, Acumen Hypotension Prediction Index – HemoSphere Advanced Monitoring Platform, Acumen Hypotension Prediction Index – HemoSphere Advanced Monitoring Platform - Pressure
• Applicant: Edwards Lifeciences, LLC
• Product Code: QAQ · Cardiovascular
• Decision Date: May 21, 2019
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 870.2210
• Device Class: Class 2
• Attributes: AI/ML

Intended Use

The Edwards Lifesciences Acumen Hypotension Prediction Index feature provides the clinician with physiological insight into a patient's likelihood of future hypotensive events (defined as mean arterial pressure < 65 mmHg for at least one minute in duration) and the associated hemodynamics. The Acumen HPI feature is intended for use in surgical or non-surgical patients receiving advanced hemodynamic monitoring. The Acumen HPI feature is considered to be additional quantitative information regarding the patient's physiological condition for reference only and no therapeutic decisions should be made based solely on the Hypotension Prediction Index (HPI) parameter.

Device Story

Software feature for EV1000 and HemoSphere monitoring platforms; inputs arterial pressure waveforms from radial arterial catheter via FloTrac IQ or Acumen IQ transducer. Calculates Hypotension Prediction Index (HPI) representing likelihood of hypotensive event (MAP < 65 mmHg) within 15 minutes; scale 0-100. Also calculates Dynamic Arterial Elastance (Eadyn) and Systolic Slope (dP/dt). Used in clinical settings by clinicians to gain physiological insight; provides adjunctive quantitative information. Does not replace clinical judgment; therapeutic decisions require review of patient hemodynamics. Benefits include early identification of potential hypotension, allowing proactive clinical management.

Clinical Evidence

Clinical performance data provided to demonstrate substantial equivalence for use in non-surgical patients. Data supports that the HPI software performance in non-surgical patients is equivalent to its performance in surgical patients.

Technological Characteristics

Software-based feature running on EV1000 and HemoSphere monitoring platforms. Uses arterial pressure waveform data from extravascular blood pressure transducers. Provides HPI, Eadyn, and dP/dt parameters. No hardware modifications from predicate.

Indications for Use

Indicated for surgical or non-surgical patients receiving advanced hemodynamic monitoring to provide insight into the likelihood of future hypotensive events (MAP < 65 mmHg for at least one minute).

Regulatory Classification

Identification

The adjunctive predictive cardiovascular indicator is a prescription device that uses software algorithms to analyze cardiovascular vital signs and predict future cardiovascular status or events. This device is intended for adjunctive use with other physical vital sign parameters and patient information and is not intended to independently direct therapy.

Special Controls

*Classification.* Class II (special controls). The special controls for this device are:(1) A software description and the results of verification and validation testing based on a comprehensive hazard analysis and risk assessment must be provided, including: (i) A full characterization of the software technical parameters, including algorithms; (ii) A description of the expected impact of all applicable sensor acquisition hardware characteristics and associated hardware specifications; (iii) A description of sensor data quality control measures; (iv) A description of all mitigations for user error or failure of any subsystem components (including signal detection, signal analysis, data display, and storage) on output accuracy; (v) A description of the expected time to patient status or clinical event for all expected outputs, accounting for differences in patient condition and environment; and (vi) The sensitivity, specificity, positive predictive value, and negative predictive value in both percentage and number form. (2) A scientific justification for the validity of the predictive cardiovascular indicator algorithm(s) must be provided. This justification must include verification of the algorithm calculations and validation using an independent data set. (3) A human factors and usability engineering assessment must be provided that evaluates the risk of misinterpretation of device output. (4) A clinical data assessment must be provided. This assessment must fulfill the following: (i) The assessment must include a summary of the clinical data used, including source, patient demographics, and any techniques used for annotating and separating the data. (ii) The clinical data must be representative of the intended use population for the device. Any selection criteria or sample limitations must be fully described and justified. (iii) The assessment must demonstrate output consistency using the expected range of data sources and data quality encountered in the intended use population and environment. (iv) The assessment must evaluate how the device output correlates with the predicted event or status. (5) Labeling must include: (i) A description of what the device measures and outputs to the user; (ii) Warnings identifying sensor acquisition factors that may impact measurement results; (iii) Guidance for interpretation of the measurements, including a statement that the output is adjunctive to other physical vital sign parameters and patient information; (iv) A specific time or a range of times before the predicted patient status or clinical event occurs, accounting for differences in patient condition and environment; (v) Key assumptions made during calculation of the output; (vi) The type(s) of sensor data used, including specification of compatible sensors for data acquisition; (vii) The expected performance of the device for all intended use populations and environments; and (viii) Relevant characteristics of the patients studied in the clinical validation (including age, gender, race or ethnicity, and patient condition) and a summary of validation results.

Predicate Devices

• Acumen Hypotension Prediction Index (DEN160044)

Reference Devices

• HemoSphere Advanced Monitoring Platform (K180881)
• FloTrac IQ or Acumen IQ extravascular blood pressure transducer (K152980)

Submission Summary (Full Text)

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Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: the Department of Health & Human Services logo on the left and the FDA logo on the right. The FDA logo features the letters "FDA" in a blue square, followed by the words "U.S. FOOD & DRUG ADMINISTRATION" in blue text.

Edwards Lifeciences, LLC Lisa Gilman Senior Manager, Regulatory Affairs One Edwards Way Irvine, California 92614

Re: K183646

Trade/Device Name: Acumen Hypotension Prediction Index Regulation Number: 21 CFR 870.2210 Regulation Name: Adiunctive Predictive Cardiovascular Indicator Regulatory Class: Class II Product Code: QAO Dated: May 16, 2019 Received: May 17, 2019

Dear Lisa Gilman:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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.

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 of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see

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https://www.fda.gov/CombinationProducts/GuidanceRegulatoryInformation/ucm597488.html; good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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 comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/) and CDRH Learn (http://www.fda.gov/Training/CDRHLearn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (http://www.fda.gov/DICE) for more information or contact DICE by email ([e-mail]) or phone [phone] or 301-796-7100).

Sincerely,

Matthew Hillebrenner Director Division of Cardiac Electrophysiology, Diagnostics and Monitoring Devices Office of Cardiovascular Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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## Indications for Use

510(k) Number (if known) K183646

Device Name Acumen Hypotension Prediction Index

#### Indications for Use (Describe)

The Edwards Lifesciences Acumen Hypotension Prediction Index feature provides the clinician with physiological insight into a patient's likelihood of future hypotensive events (defined as mean arterial pressure < 65 mmHg for at least one minute in duration) and the associated hemodynamics. The Acumen HPI feature is intended for nonsurgical patients receiving advanced hemodynamic monitoring. The Acumen HPI feature is considered to be additional quantitative information regarding the patient's physiological condition for reference only and no therapeutic decisions should be made based solely on the Hypotension Prediction Index (HPI) parameter.

| Type of Use (Select one or both, as applicable) | |
|-------------------------------------------------------------------------------|------------------------------------------------------------------------------|
| <div> <span> </span> Prescription Use (Part 21 CFR 801 Subpart D) </div> | <div> <span> </span> Over-The-Counter Use (21 CFR 801 Subpart C) </div> |

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# SECTION 5 – 510(k) SUMMARY

| Acumen™ Hypotension Prediction Index | |
|----------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 510(k)<br>Submitter | Edwards Lifesciences, LLC |
| Contact<br>Person | Lisa Gilman |
| Date Prepared | May 17, 2019 |
| Trade Name | Acumen™ Hypotension Prediction Index |
| Common<br>Name | Adjunctive Predictive Cardiovascular Indicator |
| Classification<br>Name | Adjunctive Predictive Cardiovascular Indicator |
| Regulation<br>Class / Product<br>Code | 21 CFR 870.2210/Class II/QAQ |
| Predicate<br>Device(s) | Acumen Hypotension Prediction Index, DEN160044 |
| Device<br>Description | The Acumen Hypotension Prediction Index Feature (DEN160044) consists<br>of software running on the Edwards Lifesciences EV1000 Clinical Platform<br>(DEN160044) and HemoSphere Advanced Monitoring Platform (K180881)<br>paired with the FloTrac IQ or Acumen IQ extravascular blood pressure<br>transducer (K152980) and a radial arterial catheter. The software includes<br>the Acumen Hypotension Prediction Index (HPI), the Dynamic Arterial<br>Elastance Parameter (Eadyn), the Systolic Slope Parameter (dP/dt), and<br>additional graphical user interface features.<br>The Acumen Hypotension Prediction Index is an index related to the<br>likelihood of a patient experiencing a hypotensive event (defined as mean<br>arterial pressure (MAP) $ < 65 $ mmHg for one minute in duration) within 15<br>minutes, where zero (0) indicates low likelihood and one hundred (100)<br>indicates high likelihood. The Acumen Hypotension Prediction Index, HPI,<br>should not be used exclusively to treat patients. A review of the patient's<br>hemodynamics is recommended prior to initiating treatment. |
| Indications for<br>Use/Intended<br>Use | The Edwards Lifesciences Acumen Hypotension Prediction Index feature<br>provides the clinician with physiological insight into a patient's likelihood<br>of future hypotensive events (defined as mean arterial pressure < 65 mmHg<br>for at least one minute in duration) and the associated hemodynamics. The<br>Acumen HPI feature is intended for use in surgical or non-surgical patients<br>receiving advanced hemodynamic monitoring. The Acumen HPI feature is<br>considered to be additional quantitative information regarding the patient's<br>physiological condition for reference only and no therapeutic decisions<br>should be made based solely on the Hypotension Prediction Index (HPI)<br>parameter. |
| Comparison to<br>Predicate<br>Device | The Acumen™ Hypotension Prediction Index Feature Software<br>(DEN160044, granted March 16, 2018)<br><br>Modifications<br>The labeling of the EV1000A Clinical Platform and the<br>HemoSphere Advanced Monitoring Platform has been modified to<br>expand the indications for use from surgical [operating room (OR)]<br>patients to surgical or non-surgical patients. The graphical user interface of the EV1000A Clinical Platform and<br>the HemoSphere Advanced Monitoring Platform has been modified<br>to define:<br>dP/dt parameter as systolic slope; and, Eadyn parameter as dynamic arterial elastance. There are no modifications to the hardware of the monitoring<br>platforms. |
| Performance<br>Data | Clinical Performance<br>Clinical performance data were provided to demonstrate substantial<br>equivalence of use of the Acumen™ Hypotension Prediction Index<br>software. |
| Conclusion | Overall Conclusion<br>The clinical performance data demonstrate that the Acumen™ Hypotension<br>Prediction Index software used in non-surgical patients is substantially<br>equivalent to use in surgical patients. |

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