Surgical Infection Society Statement on EBOLA
Surgeons in North America need to be prepared to evaluate and operate onpatients with the EBOLA virus. In the limited literature that exists, most clinicalobservations include abdominal pain. 1-6 The first case of EBOLA diagnosed in
the United States presented with a constellation of symptoms that included
abdominal pain.
We can anticipate that surgeons will be consulted for abdominal pain in patients
who have EBOLA. Additionally, surgical emergencies not related to the EBOLA
virus will arise in patients with EBOLA and perhaps those with suspected EBOLA.
The effect of EBOLA on surgical outcomes is not known, however because of therapid progression of the infection, it is anticipated that the prognosis after surgery
will remain guarded.
There is experience with surgery in other communicable diseases. The American
College of Surgeons “Statement on the Surgeon and HIV Infection” recommends
that using the highest standards of infection control, surgeons are ethicallyobligated to render care to HIV-infected patients. 7 EBOLA appears to be moreeasily transmitted than HIV, but the CDC has recommendations for infection
control by healthcare workers aiding EBOLA patients, to include standard,contact, and droplet precautions. 8 Additionally, the WHO has publishedguidelines on protective measures for medical staff.9There is research into existing medications that may inhibit cell entry for theEBOLA virus. In cell culture, amiodarone, verapamil, and dronedarone inhibit cell
entry by filovirus, which includes the EBOLA virus. 10 There is no clinicalevidence regarding the effect of these drugs on acquisition of EBOLA inhealthcare workers who have been exposed. The gravity of the situation maywarrant a clinical trial.
There is little information on the critical care management of EBOLA patients. In
one animal study, EBOLA caused hypotension, tachycardia, tachypnea, acidosis,
and renal failure. Treatment with normal saline attenuated the renal failure, but
did not affect mortality.11 At present, no specific recommendations can be maderegarding how to manage patients with EBOLA who are critically ill.
While we are faced with an incompletely understood challenge, the basic
principles of compassionate care using the best available science apply to thecurrent situation. Surgeons must remain abreast of the latest developments inorder to be prepared to safely care for patients with EBOLA and surgicalproblems.

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