Evidence-based guidelines for supportive care of patients with Ebola virus disease

Abstract

The 2013-16 Ebola virus disease outbreak in west Africa was associated with unprecedented challenges in the provision of care to patients with Ebola virus disease, including absence of pre-existing isolation and treatment facilities, patients' reluctance to present for medical care, and limitations in the provision of supportive medical care. Case fatality rates in west Africa were initially greater than 70%, but decreased with improvements in supportive care. To inform optimal care in a future outbreak of Ebola virus disease, we employed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to develop evidence-based guidelines for the delivery of supportive care to patients admitted to Ebola treatment units. Key recommendations include administration of oral and, as necessary, intravenous hydration; systematic monitoring of vital signs and volume status; availability of key biochemical testing; adequate staffing ratios; and availability of analgesics, including opioids, for pain relief.

Biothreat Agents and Emerging Infectious Disease in the Emergency Department

“…The recent experience with Ebola highlighted the fact that simple supportive care with fluids and electrolytes brought fatality rates down from 90% to less than 40%. 20 There are several experimental treatments and vaccines (which can be used for postexposure prophylaxis) that are available for filovirus infections and arenavirus infections that would likely be used in any domestic VHF cases caused by these groups of viruses. 21 For Ebola exposures, the experimental vaccine would be indicated for postexposure prophylaxis whereas a combination of experimental antiviral agents (eg, favipiravir) and antibody-based therapies, such as ZMapp, might be indicated after consultation with CDC.…”

Ebola Virus in the Democratic Republic of the Congo

“…In addition, clinical expertise gained during the 2014 to 2016 epidemic provided new insight into disease pathophysiology, informing care algorithms. 1,15,16 During the present epidemic in the DRC, novel approaches to the care environment in ETUs 17 have allowed for more frequent clinical monitoring and nursing care and closer fluid and electrolyte management guided by point-of-care clinical diagnostics. However, severe EVD can manifest with multiorgan failure, including renal and respiratory failure, which current ETUs are neither staffed nor equipped to manage.…”

The Special Pathogens Research Network: Enabling Research Readiness

“…However, many unanswered questions remain about the optimal supportive clinical management of patients with EVD, and ensuring access to investigational MCMs across multiple clinical sites remains a challenge. 17 Despite a lack of preparation for the conduct of clinical research specific to biocontainment units and preexisting coordination of research efforts, organizations and individuals obtained and administered investigational products on an emergency basis for the 11 EVD patients cared for at medical centers in the United States. Although patients did not receive similar MCMs under a common protocol, clinical data were shared in weekly international clinical calls to help inform care of new EVD patients and were subsequently published in the medical literature.…”