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The author observes that an incremental approach to improving basic life support (BLS) has met with limited success. Rather than continuing to optimize each of the broadly different techniques for increasing forward blood flow, we should evaluate a combination of techniques. Because human providers would likely be unable to apply such a combination, the next generation in the chain of survival, after immediate manual BLS, should be a machine. As envisioned, this machine would incorporate optimized circumferential constriction, anteroposterior compression with forceful decompression, and partial airway obstruction into one system—a combination of combinations. This may enhance both forward flow and venous return. Incorporation into a single device appears straightforward, and the mechanisms of action have the potential of additive, or even synergistic, efficacy when combined.