AIM: Mechanical assist devices are sometimes needed during resuscitation efforts of patients with prolonged cardiac arrest. Two such devices, the AutoPulse and the LUCAS, have different mechanisms of action. We propose that the effectiveness of mechanical assist devices is somewhat dependent on the configuration and compliance of the patient's chest wall. METHODS: A previous study of patients with out-of-hospital cardiac arrest in Arizona reported that survivors were younger and many were observed to have narrow anterior-posterior chest diameters. These observations suggest that the predominant mechanism of blood flow during cardiopulmonary resuscitation of individuals with primary cardiac arrest is influenced by the patient's anterior-posterior chest diameter and compliance. It is proposed that in older individuals with an increased anterior-posterior chest diameter and decreased chest compliance that the AutoPulse, which works by increasing intrathoracic pressures, may be more effective. In contrast, the LUCAS device, which works predominately by compression of the sternum, is probably more effective in patients with narrower anterior-posterior diameters and a more compliant chest. RESULTS: These hypotheses need to be confirmed by researchers who not only have access to the lateral chest roentgenograms of patients with cardiac arrest, to determine their anterior-posterior chest diameter, but also to the type of mechanical device that was used during resuscitation efforts and their patient's survival. If the observations herein proposed are confirmed, hospitals and paramedics may ideally need to have one of each type of mechanical chest compression unit and select the one to use depending on the patient's age and anterior-posterior chest diameter. CONCLUSIONS: The mechanism of blood flow in patients with cardiac arrest is predominantly secondary to cardiac compression in younger patients with narrow anterior chest diameters and predominately secondary to the thoracic pump mechanism in older patients with emphysema.