Training in advanced cardiac life support and defibrillation and community programs in cardiopulmonary resuscitation (CPR) had limited success in resuscitating patients with cardiac arrest in the Arrowhead region of Minnesota. Factors associated with survival included advanced cardiac life support within 16 minutes, ambulance traveling less than 1 mile (<1.6 km), use of paramedics, CPR within four minutes, and a call for help within two minutes. The use of technicians trained in defibrillation was associated with a statistically significant increase in hospital admissions, but not in survivors. The study failed to confirm the findings of previous studies of resuscitation in some rural areas. It was consistent, however, with reports that associated poor survival in rural areas with poor response times. No victims of unwitnessed arrests survived. Of the hospital deaths, 80% were due to neurologic causes, and overall survival was low.