Purpose To determine whether early goal-directed therapy (EGDT) reduces mortality compared with other resuscitation strategies for patients presenting to the emergency department (ED) with septic shock. Methods Using a search strategy of PubMed, EmBase and CENTRAL, we selected all relevant randomised clinical trials published from January 2000 to January 2015. We translated non-English papers and contacted authors as necessary. Our primary analysis generated a pooled odds ratio (OR) from a fixed-effect model. Sensitivity analyses explored the effect of including non-ED studies, adjusting for study quality, and conducting a random-effects model. Secondary outcomes included organ support and hospital and ICU length of stay. Results From 2395 initially eligible abstracts, five randomised clinical trials ( n  = 4735 patients) met all criteria and generally scored high for quality except for lack of blinding. There was no effect on the primary mortality outcome (EGDT: 23.2 % 495/2134 versus control: 22.4 % 582/2601; pooled OR 1.01 95 % CI 0.88–1.16, P  = 0.9, with heterogeneity I 2  = 57 %; P  = 0.055). The pooled estimate of 90-day mortality from the three recent multicentre studies ( n  = 4063) also showed no difference pooled OR 0.99 (95 % CI 0.86–1.15), P  = 0.93 with no heterogeneity ( I 2  = 0.0 %; P  = 0.97). EGDT increased vasopressor use (OR 1.25 95 % CI 1.10–1.41; P  < 0.001) and ICU admission OR 2.19 (95 % CI 1.82–2.65); P  < 0.001. Including six non-ED randomised trials increased heterogeneity ( I 2  = 71 %; P  < 0.001) but did not change overall results pooled OR 0.94 (95 % CI 0.82 to 1.07); P  = 0.33. Conclusion EGDT is not superior to usual care for ED patients with septic shock but is associated with increased utilisation of ICU resources.