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Background Following the implementation of the HeartRescue project, with interventions in the community, emergency medical services, and hospitals to improve care and outcomes for out-of-hospital cardiac arrests (OHCA) in North Carolina, improved bystander and first responder treatments as well as survival were observed. This study aimed to determine whether these improvements were consistent across Black versus White individuals. Methods and Results Using the Cardiac Arrest Registry to Enhance Survival (CARES), we identified OHCA from 16 counties in North Carolina (population 3 million) from 2010 to 2014. Temporal changes in interventions and outcomes were assessed using multilevel multivariable logistic regression, adjusted for patient and socioeconomic neighborhood-level factors. Of 7091 patients with OHCA, 36.5% were Black and 63.5% were White. Black patients were younger, more females, had more unwitnessed arrests and non-shockable rhythm (Black: 81.0%; White: 75.4%). From 2010 to 2014, the adjusted probabilities of bystander cardiopulmonary resuscitation (CPR) went from 38.5% to 51.2% in White, P <0.001; and 36.9% to 45.6% in Black, P =0.002, and first-responder defibrillation went from 13.2% to 17.2% in White, P =0.002; and 14.7% to 17.3% in Black, P =0.16. From 2010 to 2014, survival to discharge only increased in White (8.0% to 11.4%, P =0.004; Black 8.9% to 9.5%, P =0.60), though, in shockable patients the probability of survival to discharge went from 24.8% to 34.6% in White, P =0.02; and 21.7% to 29.0% in Black, P =0. 10. Conclusions After the HeartRescue program, bystander CPR and first-responder defibrillation increased in both patient groups; however, survival only increased significantly for White patients.