Insight into do-not-resuscitate protocol for COVID patients

69% of hospital physicians globally say their hospitals have already adjusted ventilator prioritization policy in case of shortages; US behind other countries

New York, New York – April 13, 2020 – The COVID-19 pandemic has put unprecedented pressure on global healthcare systems and created wartime triaging challenges that most healthcare providers have never faced. To put these situations into context, Sermo, the largest global healthcare polling company and social platform for physicians, is leveraging its capabilities to publish ongoing COVID-19 studies* with thousands of global physicians.

What to do if a patient codes

In typical medical emergencies when a patient codes, physicians use all measures to save a patient’s life. That effort requires that many HCPs work on the patient at once using techniques like de-intubation where bodily fluids from the patient can potentially spread and infect the healthcare team. Today, with the risk of infection to first responders, the “all measures“ approach seems to have changed.  

Sermo’s study reveals that over half of global physicians felt the HCP team should limit their exposure when trying to save patients’ lives. When asked, “what do you personally believe should be the protocol for COVID-19 patients that code,” the 4,982 global physician respondents said:

  • 53% – use all measures to save the patient’s life, but limit the number of healthcare professionals working on the patient
  • 26% – use all measures to save the patient’s life, with as many healthcare professionals as needed
  • 10% – do not resuscitate
  • 11% – do not know

Resuscitate or Do NOT Resuscitate? Regional differences in DNR approach

Physicians in the US are almost 3 times as likely to say ‘do not resuscitate (US 14% vs ROW 5%; n= 4982) 

Ventilator prioritization policies in hospitals have changed

Overall, 69% of hospital physicians globally reported their hospital has already adjusted the protocol for who receives a ventilator if they are in short supply (n=892 COVID treaters in hospitals). This appears to have happened earlier in Europe and ROW at ~75%, versus US at 53% and NY at 55%.

How hospital administrators and ethicists prioritize the use of ventilators; how doctors personally believe ventilators should be prioritized

We surveyed both physicians and hospitals on both their personal ethical beliefs regarding who should be prioritized for ventilator use and also asked them how their hospitals are making the same decisions. The criteria for deciding ventilator assignment included patients with the highest chance of recovery, patient most ill and at highest risk of death, first responders, age of the patient, and first come first serve.

Physicians’ personal ethical criteria versus hospitals’ ethical criteria for treating patients in a ventilator shortage

  • In choosing a hierarchy for the use of a ventilator for COVID-19 patients, physicians and hospitals agree on the first and second priority – 1, patients with the highest chance of recovery and 2, those most ill and highest risk of death.
  • However, they differ slightly on the third criteria: physicians personally believe first responders should have more priority over the age of the patient, whereas hospitals believe age of the patient should be prioritized over first responders.
  • First come first serve and age of patient were reported to be the least important criteria overall.

Physician ethical beliefs differ by country

The first wave of Sermo’s study data showed that among physicians in all countries except China, the top criteria for deciding who should receive a ventilator first was patients with the highest chance of recovery (47%) followed by those most ill and at highest risk of death (21%), and then first responders (15%).

With the pandemic changing so rapidly, Sermo re-polled the physicians on this question and the Wave II data showed an increase in prioritizing those with the highest chance of recovery across the globe:

  • 52% prioritized those with the highest chance of recovery
  • 21% those most ill and at highest risk of death
  • 14% first responders
  • 8% age of the patient
  • 5% first come first serve

“The insights gleaned from our platform provide a direct country-specific view into how physicians are responding to this pandemic. While similar challenges are global in nature, responses vary and tension points around the ethical decisions these physicians are facing come to light,” said Peter Kirk, CEO, Sermo.

 The second study wave represents more than 4,982 physicians in 30 countries. The data focuses on questions around ethical dilemmas, such as ventilator shortages, physician decisions on patient prioritization, what to do if a patient codes, and more. The data also analyzes differences in response to these dilemmas by country. To view full results and country breakdowns, visit *Results provide physician observations but are not a substitute for official medical guidelines. 


Results are reported for individual countries with a minimum sample size of 250. Such a sample size provides for point estimates with a +/- 6% precision at a 94% confidence level.  Thirty countries included in the study are the United States, Canada, Argentina, Brazil, Mexico, Germany, Italy, the United Kingdom, France, Spain, Belgium, the Netherlands, Sweden, Turkey, Poland, Russia, Finland, Ireland, Switzerland, Austria, Denmark, Norway, Greece, Taiwan, Japan, South Korea, Australia, China, India, and Hong Kong. No incentive was offered to respondents. Full methodology.

About Sermo

Sermo is the largest healthcare data collection company and social platform for physicians, reaching 1,3MM HCPs across 150 countries. The platform enables doctors to anonymously talk real-world medicine, review treatment options via our proprietary Drug Ratings platform, collectively solve patient cases, and participate in medical market research. For more information, visit

Media Contact:

Niki Franklin
Racepoint Global on behalf of Sermo
+1 617 624 3264