Point-of-Care Cardiopulmonary Resuscitation Training and Survival With Favorable Neurologic Outcome in Cardiac Arrest in Pediatric ICUs—Reply

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In Reply We agree that clinicians and educators should interpret our study1 findings carefully and not conclude that these types of physiologic point-of-care CPR trainings and debriefings are ineffective based on a trial that was negative for the primary outcome. Dr McGaghie and colleagues have consistently and appropriately advocated that ideally, the successful knowledge, skill, and behavior acquisition of an individual would be tracked after training and linked to improved performance at the bedside, patient outcomes, and system/population effects. We agree that high-fidelity, time-intensive, comprehensive training programs are most likely to improve performance and behaviors of bedside teams in complex clinical scenarios.2 Unfortunately, this approach lowers multicenter trial feasibility. Therefore, we sought to evaluate a simple bundle of evidence-informed interventions that was practical, sustainable, and likely to be widely adopted and disseminated following our trial. This decision was supported by a single-center study showing that this approach significantly improved outcomes.3 Moreover, a large body of science supports an intermittent spaced-learning approach, particularly in the field of CPR education.4,5 In fact, the AHA now offers CPR recertification via a spaced-learning program as a result of prior investigations of this educational technique.

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