Advanced organ support and rescue therapies in critically ill adults with severe yellow fever: a scoping review.

BACKGROUND

Severe yellow fever (YF) is associated with acute liver failure, multiorgan dysfunction, and mortality exceeding 60% among critically ill patients. In the absence of effective antiviral therapy, advanced organ support and rescue interventions have been increasingly used, although their clinical benefit remains uncertain.

METHODS

We conducted a scoping review following the Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. PubMed/MEDLINE, EMBASE, Scopus, Web of Science Core Collection, and LILACS were searched from inception to December 31, 2025. Eligible studies included adults with laboratory-confirmed severe YF receiving advanced organ support or rescue therapies.

RESULTS

Eight studies met the inclusion criteria, all conducted in Brazil during the 2017-2019 epidemic. Three retrospective ICU cohorts, one comparative observational study, one observational study, and three case reports were included. In-hospital mortality ranged from 47.4% to 67.0%. Intensive twice-daily therapeutic plasma exchange was associated with lower mortality than standard care (14% vs 85%; P < 0.001) in one nonrandomized study. Liver transplantation was feasible in selected patients with documented long-term survival, although graft reinfection was reported. No eligible evidence was identified for extracorporeal membrane oxygenation, hemoperfusion, or most extracorporeal liver support systems.

CONCLUSION

Evidence remains limited and predominantly observational. Intensive therapeutic plasma exchange yielded the most favorable observational signal, but its efficacy remains unproven; liver transplantation may be a rescue option for selected patients. Prospective multicenter studies are needed.