Page 40 - JSOM Fall 2024

In the present study, we used a Delphi-type consensus research website was sent by email to each of the designated experts.
method to address questions regarding the appropriateness of Analysis of the answers (in percentage terms) was directly in-
REBOA in a medicalized prehospital system. We conducted corporated into the software.
this study in order to broaden the therapeutic choices of doc-
tors practicing in prehospital settings. Description of the Various Rounds
The study was conducted over three rounds, each lasting 1
month. Each expert answered independently of the others,
Methods
and did not have access to the others’ responses, so that they
Our study was conducted following the Delphi method, which could not influence each other. During the first round, each
enables the attainment of an expert consensus on answers to expert provided information about their professional practice,
questions when appropriate scientific data are unavailable or including their place of work, specialty, and seniority, as well
8
insufficient. Our goal was to answer specific questions re- as the number of times they performed REBOA per year. In
garding the out-of-hospital use of REBOA, which could guide the first round, the 10 selected questions were posed, including
the development of a protocol for REBOA use in a medicalized open-ended questions and the option to leave comments.
prehospital system for the sole purpose of managing trauma
or postpartum bleeding. Ten questions were submitted to the For the second round, the questions that did not reach a con-
experts over three rounds. sensus were reframed, providing details regarding the pos-
sible points that were debated in the first round and posing
Protocol Drafting close-ended questions only. Finally, during the third round, the
We developed an initial protocol for REBOA use in a prehos- questions that did not reach a consensus during the first and
pital setting. To create this first protocol, we used information second rounds were again reframed, taking into account the
from the existing literature along with the question answers diversity of responses from the second round and providing
that reached a consensus using the Delphi method. more straightforward answer choices.

Description of the Delphi Study The different experts did not know each other and so they
The Delphi questionnaire approach is a qualitative research could not communicate on the questions during the rounds.
methodology commonly used to seek answers when scientific
data addressing a given problem are limited or nonexistent. For the specific question of noradrenaline dosage, we refined
It involves sending a questionnaire to various experts on the the possible dosages in each round, based on the experts’ re-
subject, to seek their input. The method is usually performed sponses. During the first round, the experts had the choice
in several rounds, with the questions asked during a round al- between three dosages ranging from 0.2 to 0.6µg/kg/min. We
tered based on the answers given by the experts in the previous refined the question according to the results of the first round.
round, until a consensus is reached. A group of 10–15 experts
can be sufficient. 9–12
Results
Consensus Requirement/Lack of Consensus Characteristics of Experts
A consensus was considered achieved when a question re- A total of 19 experts answered one or several rounds of the
ceived more than 70% common answers. A question was con- Delphi study. Table 1 presents the experts’ biographical data,
sidered to lack a consensus if it did not obtain more than 70% specialties, and experience with REBOA. All 19 experts an-
common answers in the third round. swered in the first round, second, and third rounds. Some ex-
perts did not answer all the questions, with some considering
Description of the Group of Questioners themselves unable to answer a particular question. This was
The group of questioners comprised five emergency doctors most often linked to a lack of knowledge about the practice of
or intensive care anesthesiologists, all familiar with prehos- prehospital medicine, making it impossible to transpose their
pital emergency medical practice. Each questioner was in- hospital experience.
structed to raise 10 questions relating to the general theme of
“What might be the 10 most important questions that must Final Questions Selected
be answered to validate REBOA use in a prehospital medi- for Presentation to the Experts
cal setting?” All questions were audited by three revisers who Upon completion of the three rounds, consensus answers were
excluded the questions that were already answered in the ex- achieved for 10 questions. Table 2 summarizes these questions
isting literature and then reframed the redundant questions. and the obtained answers.
The revisers selected the 10 most relevant questions that were
likely to create a debate among the emergency doctors who Discussion
could use REBOA in the prehospital setting.
Lack of Protocol for and Randomized Study
Expert Selection of Prehospital REBOA Use
The experts were selected by the head of the EVTM (EnDoVas- There are currently no reliable data regarding a protocol for
13
cular and Trauma Management) society, from among members REBOA use by a medicalized prehospital system. However,
of this society, based on their regular involvement in congresses several case series confirm the relevance of REBOA in the pre-
and their scientific contributions concerning REBOA. hospital setting. 14,15
Software Usage The resources provided to the practitioner are of greater con-
An online questionnaire was created using the SurveyMonkey sequence in a medicalized prehospital system compared with
software (SurveyMonkey, San Mateo, CA). A link to the survey a paramedic squad. This is explained by the fact that doctors

38 | JSOM Volume 24, Edition 3 / Fall 2024