The annual incidence of out-of-hospital cardiac arrests in the United States is ∼350,000-450,000 per year. The prognosis for cardiac arrest survivors remains extremely poor. Therapeutic hypothermia (TH) is the only therapy proven to improve survival and neurological outcome in these patients. This article discusses the pathophysiology of neurological injury in cardiac arrest survivors and states the presumed mechanisms by which TH mitigates brain injury in these patients. It reviews the contraindications to the use of this therapy, methods of cooling, and phases of TH and elaborates on the intensive care unit management of TH. The use of TH in ventricular fibrillation survivors has become the standard of care and continues to evolve in its application as an essential therapy in cardiac arrest patients.