MAUDE Adverse Event Report: PERFUSION SYSTEMS BIO-MEDICUS NG ARTERIAL CANNULA; CATHETER, CANNULA AND TUBING, VASCULAR, CARDIO

Model Number 96570-123

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problem Pulmonary Hypertension (4460)

Event Date 03/30/2023

Event Type  Death  

Manufacturer Narrative

Literature details: title: strategies and techniques for percutaneous veno-arterial ecmo cannulation and decannulation in children authors: buyukgoz c, sandhu h, shah s, rower k, ramakrishnan k, waller br, kiene a, knott-craig c, boston u, sathanandam s.Journal: catheter cardiovasc interv.2023 may;101(6):1088-1097.Doi: 10.1002/ccd.30649.Medtronic is submitting this report to comply with fda reporting regulations under 21 cfr parts 4 and 803.This report is based upon information obtained by medtronic, which the company may not have been able to fully investigate or verify prior to the date the report was required by the fda.Medtronic has made reasonable efforts to obtain more complete information and has provided as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.In particular, this report does not constitute an admission by anyone that the product described in this report has any ¿defects¿ or has ¿malfunctioned¿.These words are included in the fda 3500a form and are fixed items for selection created by the fda to categorize the type of event solely for the purpose of regulatory reporting.Medtronic objects to the use of these words and others like them because of the lack of definition and the connotations implied by these terms.This statement should be included with any information or report disclosed to the public under the freedom of information act.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.A good faith effort will be made to obtain the applicable information relevant to the report.If information is provided in the future, a supplemental report will be issued.

Event Description

Medtronic received information via literature regarding techniques used for percutaneous veno-arterial extracorporeal membrane oxygenation (va-ecmo) cannulation and decannulation in children.All data were collected from a single center between 2019 and 2021.The study population included 20 patients, all of which were treated with medtronic bio-medicus cannulae (serial numbers not provided).It was reported that patient 1 was treated with three bio-medicus cannulae; one in the left femoral artery, one in the left femoral vein, and one in the right internal jugular vein.They were subsequently transferred on ecmo to another institution where they died 4 days after decannulation from a pulmonary hypertensive event.

• Brand Name: BIO-MEDICUS NG ARTERIAL CANNULA
• Type of Device: CATHETER, CANNULA AND TUBING, VASCULAR, CARDIO
• Manufacturer (Section D): PERFUSION SYSTEMS; 7611 northland dr; brooklyn park MN 55428
• Manufacturer (Section G): PERFUSION SYSTEMS; 7611 northland dr; brooklyn park MN 55428
• Manufacturer Contact: alison sweeney ; parkmore business park west; galway ; EI ; 091708096
• MDR Report Key: 17948505
• MDR Text Key: 325803757
• Report Number: 2184009-2023-00989
• Device Sequence Number: 1
• Product Code: DWF
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K142673
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Literature,Health Professional,Company Representative
• Reporter Occupation: Physician
• Type of Report: Initial
• Report Date: 10/17/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 10/17/2023
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Model Number: 96570-123
• Device Catalogue Number: 96570-123
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 09/20/2023
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention; Death
• Patient Age: 15 YR
• Patient Sex: Female
• Patient Weight: 60 KG