A hybrid chest compression device includes a backboard with a motor and a drive spool housed within the backboard. There is also a piston support frame secured to the backboard forming a patient channel between the piston support frame and the backboard. There is a belt operably secured to the drive spool and enclosed within the backboard and the piston support frame and a piston operably housed within the piston support frame wherein motion of the belt actuates motion of the piston. Actuation of the motor results in cyclic rotation and counter-rotation of the motor and corresponding winding and unwinding of the belt on the drive spool to effectuate cyclic extension and retraction of the piston against the patient's chest to perform mechanical cardiopulmonary resuscitation.