The quality of evidence is downgraded by study limitations (incomplete outcome data).
A Cochrane review «Adrenaline and vasopressin for cardiac arrest»1 «Finn J, Jacobs I, Williams TA et al. Adrenaline and vasopressin for cardiac arrest. Cochrane Database Syst Rev 2019;(1):CD003179. »1 included 21 studies with a total of 21 704 subjects. The review provided moderate-quality evidence that standard-dose adrenaline compared to placebo improves return of spontaneous circulation, survival to hospital admission and survival to hospital discharge, but low-quality evidence that it did not affect survival with a favourable neurological outcome (table «Standard-dose adrenaline (SDA) compared to placebo for out-of-hospital cardiac arrest.»1). Many of the studies were conducted more than 20 years ago.
| Outcome | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | Participants (studies) | Certainty of evidence (GRADE) | |
| Risk with placebo | Risk with SDA | ||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio | |||||
| Survival to hospital discharge | 23 per 1000 | 32 per 1000 (25 to 42) | RR 1.44 (1.11 to 1.86) | 8538 (2) | Moderate (B) |
| Survival to hospital admission | 83 per 1000 | 209 per 1000 (139 to 313) | RR 2.51 (1.67 to 3.76) | 8489 (2) | Moderate (B) |
| Favourable neurological outcomes | 19 per 1000 | 22 per 1000 (17 to 30) | RR 1.21 (0.90 to 1.62) | 8535 (2) | Low (C) |