Expedited transfer pathways vs. standard care for adults with out-of-hospital cardiac arrest: a systematic review and meta-analysis of randomized trials.

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.