2025 年 7 巻 12 号 p. 1298-1300
Background: This study retrospectively evaluated the safety of resuscitation training during the Coronavirus Disease 2019 (COVID-19) pandemic under Japan Resuscitation Council (JRC) guidance.
Methods and Results: From 2018 to 2024, all participating staff were monitored by the Infection Prevention and Control Center. Although learner numbers declined in 2020, training sessions increased, and numbers returned to prepandemic levels. The Resuscitation Quality Improvement program enabled flexible, contactless training, further boosting participation. Notably, no COVID-19 cases were linked to training sessions.
Conclusions: These findings demonstrate that resuscitation training can be conducted safely by adhering to JRC guidance, even during a public health crisis.
Performing cardiopulmonary resuscitation (CPR) is essential for all hospital staff. However, during the Coronavirus Disease 2019 (COVID-19) pandemic, CPR training was suspended nationwide due to transmission concerns. In response, the Japan Resuscitation Council (JRC) issued its “Guidance for Resuscitation Training During the COVID-19 Pandemic” on November 17, 2020.1 Based on this guidance, Dokkyo Medical University Hospital (DMUH) resumed CPR training. This study aimed to retrospectively evaluate whether CPR training was resumed safely without contributing to the spread of COVID-19, while maintaining learner engagement.
DMUH, a regional tertiary care center with 1,195 beds and a helicopter emergency medical service base, implemented the American Heart Association-based resuscitation training2 for all hospital staff.3 The Basic Life Support (BLS) course is mandatory for clinical residents and new nurses. All staff, including security and administrative personnel, were required to complete the Family and Friends, Heartsaver CPR AED, or BLS course. The Resuscitation Quality Improvement (RQI) program, a flexible, low-dose, high-frequency, contactless, self-directed training, was introduced in 2019.4 From 2021, the BLS course was replaced by the HeartCode BLS course, a blended learning format combining online and in-person elements of the BLS program.
All staff of DMUH who participated in any resuscitation training from April 2018 to March 2024 (fiscal year (FY) 2018–2023) were included in the study. Training resumed in November 2020, in accordance with JRC guidance and the Infection Prevention and Control Center (IPCC) precautionary protocols (Figure A).
(A) Infection prevention and control measures in training. In accordance with JRC guidance and the Infection Prevention and Control Center (IPCC) precautionary protocols, which included: (1) hand sanitization, temperature checks, and health questionnaires at reception, (2) mandatory masks, gloves, and eye protection for all participants, (3) well-ventilated rooms and physical distancing, (4) one mannequin per learner, with disinfection after each session, (5) replacement of all disposable materials after use, (6) with disinfection protocols enforced before and after use. (B) Number of learners and number of CPR training courses held by year. BLS, basic life support course; F&F, Family and Friends course; FY, fiscal year; HCBLS, HeartCode BLS course; HSAED, Heartsaver CPR AED course; RQI, Resuscitation Quality Improvement program.
The IPCC centrally managed all health data, including COVID-19-related information, throughout the institution. It monitored participants’ health to ensure that training could be safely conducted. Follow-up procedures required participants, both learners and instructors, to self-report illness and if a participant reported feeling unwell, the IPCC conducted a real-time PCR test for COVID-19 to confirm the diagnosis, regardless of the participant’s COVID-19 antigen self-test result.
Although CPR training was suspended nationwide during the early stages of the COVID-19 pandemic in early 2020, DMUH resumed training in November 2020. In FY2018, before the pandemic, there were 12 training sessions and 424 learners (Figure B). In FY2019, training sessions increased to 19, with 317 learners. Following suspension, learner numbers dropped to 77 in FY2020. However, by increasing the number of sessions with restricted learners per session, learner numbers returned to prepandemic levels: 300 in FY2021, 230 in FY2022, and 204 in FY2023. Participation in the RQI program introduced in FY2019 increased from 243 learners in FY2019 to 439 in FY2023.
Despite COVID-19 surges in Japan (waves 3–8), no infections were linked to CPR training at our institution.
The results of this study demonstrate that CPR training was safely conducted during a pandemic with strict infection control. No outbreaks occurred, and participation was maintained through adaptive measures and program diversification. These findings support JRC guidance and the role of centralized infection control by bodies such as the IPCC.
Despite JRC guidance, many institutions hesitated to resume CPR training, likely due to outbreak concerns and uncertainty. At DMUH, training resumed under IPCC-led monitoring and infection prevention protocols, supported by institutional trust in its oversight.
Currently, hands-on, instructor-led, manikin-based training remains the gold standard, especially when stringent infection control measures are implemented. The RQI program also proved beneficial by allowing training to continue even during the pandemic. Designed as flexible, low-dose, high-frequency, and self-directed training, its non-contact format served as an alternative when in-person training was restricted.
CPR training was safely resumed during the COVID-19 pandemic through strict adherence to JRC and institutional infection control protocols. No training-related outbreaks occurred. These findings validate the JRC guidance and provide a model for maintaining essential training during future public health crises.
All authors declare no conflicts of interest.
No funding was received.
Ethics approval was exempted by DMUH due to this study’s retrospective observational design.
Y.S. collected and analyzed the data. M.K. drafted the manuscript. Y.S. and M.K. reviewed it. All authors contributed to data interpretation, discussion, and manuscript development and approved the final version, taking full responsibility for its integrity and accuracy.
Data supporting this study are available from IPCC, Faculty and Staff Development Center, and Clinical Training Center but are not publicly accessible due to licensing restrictions. They can be obtained from the corresponding authors upon reasonable request and with permission from these centers.
