A58-year-old man presented to the emergency department (ED) pulseless and with severe hypothermia. The patient received standard Advanced Cardiac Life Support (ACLS) measures and mechanical cardiopulmonary resuscitation for 57 minutes before regaining a pulse. In addition to other traditional passive and active measures, the patient was gradually rewarmed (~1°C per hour) with an endovascular catheter in the ED with therapeutic hypothermia at 33°C maintained for 12 hours during his intensive care unit (ICU) stay. He was then rewarmed to normothermia over 15 hours and ultimately discharged at his neurologic baseline 11 days later. This case study explores the 3 issues that make this instance of cardiac arrest caused by severe hypothermia treated with an endovascular catheter unique: (1) graduated rewarming at ~1°C per hour, (2) combined treatment with therapeutic hypothermia, and (3) return to baseline neurologic status at discharge. © 2012 Elsevier Inc.