Background <p>The International Liaison Committee on Resuscitation recommends initiating chest compressions (CC) in newborns when heart rate (HR) is &lt;60 beats per minute (bpm) after 30 s of effective positive pressure ventilation (PPV).</p> Methods <p>Near-term lambs with asphyxia induced bradycardia (HR &lt; 60 bpm) were randomized to: (i) control (<i>n</i> = 6)— Resuscitation per current Neonatal Resuscitation Program (NRP) (ii) study (<i>n</i> = 6)—PPV continued until HR = 0, only then CC with PPV were administered in a ratio of 3:1 until return of spontaneous circulation (ROSC). Outcomes included timing, incidence of ROSC, CC requirement, blood gases, and peak coronary, carotid, and pulmonary blood flow.</p> Results <p>The time to achieve ROSC was not different between groups (3 ± 2 min vs. 1.6 ± 1 min in study (<i>p</i> = 0.17). Only 1/6 lambs in study group required CC versus 6/6 in control group (<i>p</i> = 0.015). At ROSC, the study group had significantly lower arterial PaCO2 (47 ± 5 mmHg vs. 94 ± 18 mmHg, <i>p</i> &lt; 0.01) and higher arterial PaO₂ (148 ± 53 mmHg vs. 54 ± 12 mmHg, <i>p</i> &lt; 0.01). The asynchronous external CC in the control group contributed to the loss of inherent cardiac activity.</p> Conclusion <p>Prioritizing ventilation during bradycardia reduced need for CC, facilitated faster ROSC, and improved gas exchange in an ovine model.</p> Impact <p><UnorderedList Mark="Bullet"> <ItemContent> <p>Prioritizing ventilation over chest compressions beyond 30 s for bradycardia during neonatal resuscitation improves outcomes, reducing the need for chest compressions and accelerating the time to return of spontaneous circulation.</p> </ItemContent> <ItemContent> <p>Pulseless electrical activity occurs before complete cardiac arrest.</p> </ItemContent> <ItemContent> <p>Focusing on initiating chest compressions at a specific heart rate will distract providers from prioritizing ventilation.</p> </ItemContent> </UnorderedList></p>