The team performs a full minute of coordinated chest compressions and ventilations before pausing to reassess the baby’s heart rate. The team is careful to avoid unnecessary pauses in chest compressions to prevent a reduction in coronary artery perfusion. 

An ECG monitor is the preferred method for assessing the baby’s heart rate during this time. Listening with a stethoscope, palpating the umbilical cord, or using the HR measurement from a pulse oximeter are secondary methods. The use of a stethoscope during resuscitation is not reliable and is prone to prolonging pauses in chest compressions. A pulse oximeter reading may not be accurate since perfusion is poor during cardiac arrest.

Although ECG assessment shortens the interruptions in chest compressions, the team must watch for pulseless electrical activity (PEA). If the rhythm is PEA, the team may mistakenly think that the patient has cardiac function. Therefore, confirming an improved heart rate by palpation or with a stethoscope is an essential secondary assessment. 

If the heart rate has not improved at the 1-minute mark, chest compressions and coordinated ventilation are quickly resumed. The quality of PPV and compressions should be reassessed. 

The team:

• Looks for visible chest rise
• Auscultates for bilateral breath sounds
• Verifies 100% oxygen concentration
• Verifies high-quality chest compressions (correct depth and full recoil)
• Ensures that the compression rate is correct
• Ensures coordination of chest compressions and breaths

After performing any needed corrective measures, chest compressions and PPV continue for another full minute before the team reassesses the heart rate. If the heart rate does not improve, the team member assigned to medications prepares to administer epinephrine.Intravenous access via umbilical venous catheterization or intraosseous needle insertion is obtained if not already done.