Mechanical chest compression with cardiac defibrillation does not improve 4 h survival compared with manual cardiopulmonary resuscitation (CPR) in patients with out-of-hospital cardiac arrest. The randomized LINC trial was conducted in the Netherlands, Sweden, and the UK, and involved 2,589 patients who underwent CPR with the mechanical LUCAS® Chest Compression System (Jolife AB, Sweden / Physio-Control, Inc., USA) or manual CPR as directed by European guidelines. Survival at 4 h after cardiac arrest was similar in the mechanical and manual CPR groups (23.6% and 23.7%, respectively). No differences were noted in survival at 1 or 6 months between the two interventions. Neurological outcome among survivors was good in both groups (cerebral performance category score 1 or 2 in 99% of patients in the mechanical CPR group, and 94% in the manual CPR group).