We have reported the epidemiology and survival rate of out-of-hospital cardiac arrest (OOH-CA) in a north-east region of Italy previously, the Friuli-Venezia-Giulia Arrest Cooperative Study (FACS). We present the results of a second observational, prospective, multicentre study on OOH-CA victims in a local area in the same geographical Italian region.The area investigated, Pordenone province, is representative of the entire region studied in 1994. In the 1994 FACS study, the heterogeneous ambulance personnel, ranging from volunteers to registered nurses and physicians, were not all trained in basic life support and early defibrillation. In 2003 all rescuers had advanced cardiac life support (ACLS) skills. Moreover, in 2003 dispatch-guided CPR was used. The time from dispatch to defibrillation of victims of OOH-CA from cardiac aetiology was comparable between 1994 and 2003. However, the rate of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) as presenting rhythm decreased significantly between 1994 and 2003 from 30.2% to 20.1% (p < 0.05). Despite this, survival to hospital discharge for VF/VT almost tripled (15.4% versus 41.0%; p < 0.05). Hospital discharge for asystole or pulseless electrical activity remained dismal (3.1% and 1.7%).Despite a reduction in the rate of VF/VT as presenting rhythm, survival was almost tripled. Manning all ambulances with professional emergency medical personnel and ACLS training together with dispatch-guided CPR may have contributed to the improvements observed in survival rates.