Conducting multicenter simulation-based experimental research: lessons drawn from the Quality CPR European project

Multicenter research designs are widely recognized for enhancing the generalizability and real-world applicability of findings across diverse healthcare settings. However, conducting experimental studies across international sites presents substantial methodological, logistical, and operational challenges. Quality CPR was a European multicenter simulation-based experimental study conducted across academic institutions in Portugal, Germany, and Finland. Using a randomized crossover design, the study investigated factors influencing chest compression quality and rescuer fatigue during simulated cardiopulmonary resuscitation. Rather than serving as a methodological guide, this paper reflects on the practical experience of designing and implementing the Quality CPR study, highlighting twelve key lessons across the research lifecycle-planning, development, execution, and dissemination. These include collaborative protocol design, the development of a practical researcher guide to ensure cross-site harmonization, active support and real-time data monitoring during execution, and integrated dissemination strategies throughout the project lifecycle. By documenting the enablers of success, this paper provides a practical reference for researchers planning similar international, multicenter studies. The insights offered aim to support the growing community of healthcare researchers engaged in cross-institutional initiatives.