Background Acute stroke can lead to morbidity and mortality. The time-critical nature of stroke care has led to a greater emphasis on robust prehospital care. Increasingly, stroke triage and consideration for earlier management are the focus of trials. There is growing evidence of early adverse physiological parameters affecting long-term patient outcomes. There is concern amongst prehospital care providers as to how to balance the need for rapid transfer with potential increased monitoring. This systematic review aims to explore existing literature on prehospital physiological monitoring and interventions, and how these may affect patient outcomes.

Methods The systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Study eligibility was determined by searching across four databases (MEDLINE, EMBASE, CINAHL and CENTRAL): (1) all study types; (2) English full-text studies involving patients with suspected acute stroke receiving prehospital care (≥18 years).

Results 741 records met the search criteria, however following screening only 19 records were deemed eligible for full-text review. Records were categorised as physiological monitoring or pharmacological therapy. Studies examining physiological monitoring (n=7) assessed the association between prehospital blood pressure and early neurological deterioration and hematoma volume. One study examined the feasibility of prehospital HRV assessment and its relationship to patient outcomes. In terms of pharmacological therapy, (n=3) RCTs evaluated the effectiveness of prehospital BP-lowering interventions. (n=2) studies investigated the effects of prehospital administration of neuroprotective agents on functional outcomes following stroke.

Conclusions It has been demonstrated that ambulance-initiated stroke patient monitoring and treatment is feasible. Although limited by heterogeneous data, the review highlighted gaps in the existing literature. Furthermore, continuous physiological parameter monitoring is feasible and recommended in future studies to improve available data on patient management and outcomes.