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 PRISMA-ScR 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. CONCLUSIONS: Evidence remains limited and predominantly observational. Intensive TPE 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.