Expedited transfer pathways vs. standard care for adults with out-of-hospital cardiac arrest: a systematic review and meta-analysis of randomized trials.
Frontiers in Medicine · 2026-01-01 · Meta-analysis
Abstract
BACKGROUND: In adults with out-of-hospital cardiac arrest (OHCA), the clinical benefit of expedited transfer compared with standard resuscitation pathways remains uncertain. This study aimed to evaluate randomized controlled trial evidence on the effects of expedited transfer on survival and neurological outcomes. METHODS: PubMed, MEDLINE, Embase, and Scopus were searched from inception to 22 February 2026. Eligible studies were randomized controlled trials comparing expedited transfer with standard care in adults with prehospital OHCA. The primary outcome was all-cause mortality at the longest reported follow-up; secondary outcomes included neurological recovery, bleeding, mechanical circulatory support, time to return of spontaneous circulation, and length of hospital stay. Random-effects meta-analyses were performed; risk of bias was assessed using RoB 2, certainty of evidence using GRADE. Subgroup analyses were conducted according to clinical pathway type, comparing post-ROSC transfer to cardiac arrest centers with intra-arrest transport pathways for refractory OHCA. RESULTS: Four randomized controlled trials involving 1,303 patients were included. Compared with standard care, expedited transfer did not significantly reduce all-cause mortality at the longest reported follow-up (RR = 0.97, 95% CI: 0.90-1.04) or improve favorable neurological outcome at hospital discharge (RR = 0.98, 95% CI: 0.81-1.18). No statistically significant between-group differences were observed for the remaining secondary outcomes. Sensitivity analyses were consistent with the primary analysis. Subgroup analysis showed no significant interaction according to expedited transfer pathway type (P for subgroup difference = 0.46). CONCLUSION: Current randomized evidence does not support routine expedited transfer as a standard strategy for adults with OHCA.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Mortality & survival · Quality of life & function · Time intervals
Related articles
- Unraveling the Consequences of the COVID-19 Pandemic on Out-of-hospital Cardiac Arrest: A Systematic Review and Meta-analysis (Eurasian Journal of Emergency Medicine, 2023)
- Intraarrest transport, extracorporeal cardiopulmonary resuscitation, and early invasive management in refractory out-of-hospital cardiac arrest: an individual patient data pooled analysis of two randomised trials. (EClinicalMedicine, 2023)
- Comparison of out-of-hospital cardiac arrests during the COVID-19 pandemic with those before the pandemic: an updated systematic review and meta-analysis. (Front Public Health, 2023)
- Does transport time of out-of-hospital cardiac arrest patients matter? A systematic review and meta-analysis. (Resuscitation, 2017)
- Low-flow time and neurological outcomes in out-of-hospital cardiac arrest: implications for prehospital care quality and health outcomes. (Int J Emerg Med, 2026)
- Time from Cardiopulmonary Resuscitation Initiation to Prehospital Return of Spontaneous Circulation and Downstream Outcomes Among Adult Out-of-Hospital Cardiac Arrest Patients Achieving Field ROSC: A 2015-2023 Smart Advanced Life Support Registry Study. (Diagnostics (Basel), 2026)