OBJECTIVE: Mechanical chest compression (CC) devices are frequently used in in-hospital and out-of-hospital settings. In this study, mechanical and manual CC in in-hospital cardiac arrest was compared in terms of survival. METHODS: Adult patients who were admitted to the emergency department (ED) for 2 years period and had cardiac arrest in the ED were included in this retrospective, observational study. Return of spontaneous circulation (ROSC), 7-day and 30-day survival and hospital discharge data were compared between the two groups of patients who underwent manual CC and those who had mechanical CC with the Lund University Cardiac Assist System-2 device. RESULTS: Although the rate of ROSC in the mechanical CC group was lower than in the manual CC group, this difference was not statistically significant (41.7% vs. 50.4%; P = 0.133). The 7-day survival rate was found to be statistically significantly higher in the mechanical CC group (19.4% vs. 8.9%; P = 0.012). The 30-day survival rate was also found to be high in the mechanical CC group, but this difference was not statistically significant (10.6% vs. 7.3%; P = 0.339). CONCLUSION: In the light of these results, we can say that the use of piston-based mechanical CC devices in ED may be beneficial. More reliable results can be obtained with a prospective study to be performed in the ED.