Background Prehospital invasive ventilation is used across a range of critically ill adult patients, yet reported practices, monitoring approaches, and clinical outcomes vary considerably be-tween systems. Existing literature has focused largely on airway management, and the overall landscape of evidence regarding invasive ventilation strategies in the prehospital setting remains unclear. This scoping review aimed to map the extent and nature of the literature on prehospital invasive ventilation in adults, describe the clinical contexts in which it is applied, and identify knowledge gaps. Methods This scoping review was conducted according to Joanna Briggs Institute methodology and PRISMA-ScR guidelines. MEDLINE (via PubMed), Embase, and the Cochrane Library were searched from inception to the date of search. Studies were eligible if they included adult patients (≥18 years) receiving invasive ventilation in a prehospital setting. Random-ized and non-randomized controlled trials and observational studies were included. Two reviewers independently screened studies, charted data, and summarized findings de-scriptively. Results A total of 3,461 records were identified, of which 25 studies met inclusion criteria. Nine studies evaluated out-of-hospital cardiac arrest, ten focused on trauma, one examined sep-tic shock, and five included mixed populations. Across clinical contexts, deviations from recommended ventilation targets—particularly hyperventilation and inconsistent appli-cation of lung-protective tidal volumes—were common. Mechanical ventilation generally improved physiological parameters compared with manual ventilation, but consistent benefits in survival or neurological outcomes were not demonstrated. Capnogra-phy-guided ventilation and real-time feedback systems improved adherence to ventilation targets. Evidence was predominantly observational and heterogeneous in design and re-porting. Conclusion Prehospital invasive ventilation in adults is characterized by substantial variability in practice and limited high-quality comparative evidence. Ventilation quality and monitor-ing may be more important than ventilation modality alone. Prospective controlled studies and standardized reporting of prehospital ventilation practices are needed to create evi-dence-based recommendations.