Objective There is still a lack of evidence regarding the efficacy of using a single point piston without suction cup mechanical cardiopulmonary resuscitation (CPR) device in the resuscitation of out of hospital cardiac arrest (OHCA) cases in a moving ambulance setting. The aim of this study is to evaluate and compare short term survival rate return of spontaneous circulation (ROSC) of emergency medical service (EMS) delivered to OHCA patients receiving single point piston without a suction cup mechanical CPR device and manual CPR. Methods This case control study was conducted using data on OHCA patients between 1 January 2017 and 31 March 2020 using part of the Pan-Asian Resuscitation Outcomes Study (PAROS) data. Cases were classified as ROSC or no ROSC. Logistic regression analysis was used for the multivariable analysis of the primary objective. Results A total of 206 cases were included in this study, 68 ROSC cases and 138 no ROSC cases. The multivariable analysis found no significant difference in the ROSC rate of EMS delivered OHCA patients who received only manual CPR and patients who received the mechanical CPR either in the EMS (OR: 0.49, 95% confidence interval [CI]: 0
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