To compare resuscitation outcomes in elderly and younger prehospital cardiac arrest victims, we used a retrospective case series over 5 years in rural advanced life support (ALS) units and a University hospital base station. Participants included 563 adult field resuscitations. Excluded were patients with noncardiac etiologies, those less than 30 years old, and those with unknown initial rhythms. Patients were grouped by age. Return of spontaneous circulation (ROSC) and survival to hospital discharge were compared by Yates' chi-square test. ALS treatment of cardiac arrest was by regional protocols and on-line physician direction. Sixty percent (320/532) of patients were over 65 years old. The proportion with initial rhythm ventricular fibrillation (VF) was 50% in the elderly and 48% in younger patients. ROSC was achieved in 18% of elderly and 16% of younger patients; survival was 4% among the elderly and 5% for younger patients. The oldest survivor was 87 years old. Most survivors were discharged, in good Cerebral Performance Categories. There was no difference in outcome by age group when initial cardiac rhythm was considered. Early cardiopulmonary resuscitation (CPR) and ALS and initial rhythm VF were associated with the best resuscitation success. Age has less effect on resuscitation success than other well-known factors such as early CPR and ALS. Advanced age alone should probably not deter resuscitation attempts.