BACKGROUND: Early goal-directed therapy (EGDT) has been used for patients with severe sepsis and septic shock in the emergency department (ED). In 2003, international management guidelines for severe sepsis and septic shock were developed under the auspices of the Surviving Sepsis Campaign (SSC); however, EGDT based on the SSC was not fully evaluated in the ED. The purpose of this study was to evaluate the efficacy of EGDT based on the SSC in the ED in Korea. METHODS: We randomly assigned patients who arrived at our ED in septic shock to receive EGDT before admission to the intensive care unit between May 2007 and July 2007, and we retrospectively assigned patients in septic shock to receive standard therapy between May 2006 and July 2006. The in-hospital mortality for 24 hours and 28 days, the MODS, SAPS II, and APACHE II scores were obtained and compared between the study groups. RESULTS: Of the 60 enrolled patients, 30 were assigned to EGDT and 30 were assigned to standard therapy. There was no significant difference between the groups with respect to the baseline characteristics. In-hospital mortality at 28 days was 13% in the group assigned to EGDT as compared to 40% in the group assigned to standard therapy (p = 0.020) and in-hospital mortality at 24 hours was 0% and 13%, respectively (p = 0.038). CONCLUSIONS: EGDT provides significant benefits with respect to outcome in patients in septic shock.