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In order to improve coronary blood flow during cardiopulmonary resuscitation (CPR), it is necessary to increase the aortic-right atrial pressure gradient. In the closed cardiovascular system, this gradient should be primarily determined by the level of cardiac output. Alternating simultaneous compression and decompression of the thorax and abdomen should result in improved cardiac output and coronary blood flow over present methods. Based on computer simulation results, this previously untried method was found to improve coronary flow three times the level predicted for standard CPR. Other recently proposed CPR strategies were also evaluated but resulted in significantly lower coronary perfusion levels. In all cases, coronary blood flow varied directly with cardiac output. The use of simultaneous compression and decompression appears to be a promising CPR procedure which warrants further consideration.