Abstract: The present invention provides a direct cardiac compression device comprising one or more passive chambers that taper from an aperture to an apex; one or more inflatable active pockets individually independently inflatable, wherein each of the one or more inflatable active pockets is connected to the one or more passive chambers at least partially from the aperture to the apex and wherein the each of the one or more inflatable active pockets does not tension the adjacent one or more inflatable active pockets upon inflation; and a frame in contact with the one or more active chambers to at least partially surround the one or more active pockets.