The priorities of airway management during cardiopulmonary resuscitation are to minimise interruptions in chest compressions, to optimise blood flow and oxygen delivery to vital organs and to minimise delays in defibrillation if the initial rhythm is shockable. Thus, during the initial treatment of cardiac arrest, unusually, the circulation takes priority over the airway. Maintaining a patent airway will enable ventilation and oxygenation of the lungs, which becomes increasingly important after the first 3–4 minutes of sudden primary cardiac arrest (i.e. of cardiac cause). The optimal airway management strategy during cardiac arrest is uncertain. Many cardiac arrest patients are treated with multiple airway devices and this stepwise approach to airway management is difficult to study in controlled trials. The results of three recent randomised clinical trials suggest tracheal intubation should only be used in those settings with a high intubation success rate. While early oxygenation and ventilation are logically more important after asphyxial cardiac arrest existing resuscitation guidelines recommend the same sequence of actions regardless.