Sudden cardiac arrest is a devastating manifestation of coronary artery disease and a leading cause of death in the western world. Early and effective cardiopulmonary resuscitation is essential for return of spontaneous circulation. If manual compression is ongoing and return of spontaneous circulation has not been achieved, the prognosis is poor, and the logistics of performing cardiac catheterization are forbidding. With the advent of mechanical chest compression, however, this clinical scenario has become much more complex. Coronary angiography and percutaneous coronary intervention, although still cumbersome, has been established as feasible with ongoing mechanical chest compression. This article discusses the strengths and pitfalls of mechanical cardiopulmonary resuscitation, our experience, and current evidence behind activation of the catheterization laboratory with ongoing mechanical chest compression. © 2013 Wiley Periodicals, Inc.