In this lively podcast debate from ResusX:ReVolved, Salim Rezaie and Anand Swaminathan tackle the contentious topic of Mechanical versus Manual CPR. Swaminathan, also known as "The Swami," begins by arguing against Mechanical CPR, asserting that there is no compelling high-quality evidence to support its superiority over Manual CPR. He emphasizes the critical importance of high-quality CPR and early defibrillation in achieving good neurologic outcomes in cardiac arrest cases. Swaminathan raises concerns about the obstacles, costs, and training required for Mechanical CPR devices, suggesting that they may not be justified in many settings. He concedes, however, that there might be a role for these devices in scenarios with limited rescuers or prolonged transport times. Rezaie, "The Rebel," counters by acknowledging their shared belief in the significance of compressions and defibrillation but argues that humans often struggle to maintain the quality of compressions. He highlights the potential cognitive offload that Mechanical CPR offers and cites a meta-analysis that found no significant difference in outcomes between Mechanical and Manual CPR. Rezaie also mentions scenarios where Mechanical CPR could be particularly beneficial, such as in ECMO/eCPR cases and scenarios with limited personnel. The debate leaves the audience with plenty to ponder regarding the use of Mechanical CPR devices in cardiac arrest management.