Therapeutic hypothermia is an important and successful treatment that has been endorsed only in specific clinical settings of cardiac arrest. Inclusion criteria thus far have not embraced drug-induced cardiac arrest, but clinical evidence has been mounting that therapeutic hypothermia may be beneficial in such cases. A 59-year-old man who experienced a cocaine-induced cardiac arrest had a full neurological recovery after use of therapeutic hypothermia. The relevant pathophysiology of cocaine-induced cardiac arrest is reviewed, the mechanism and history of therapeutic hypothermia are discussed, and the clinical evidence recommending the use of therapeutic hypothermia in cocaineinduced cardiac arrest is reinforced. (American Journal of Critical Care. 2014; 23:89-92) T herapeutic hypothermia remains a relatively new immediate treatment option for patients who have had return of spontaneous circulation after cardiac arrest but remain unresponsive. In several studies, 1 therapeutic hypothermia has been definitively shown to improve neurological recovery when used after the return of spontaneous circulation. These studies, however, excluded survivors of drug-induced cardiac arrest.2 As a result, evidence supporting the use of therapeutic hypothermia in drug-induced cardiac arrest has been absent despite clinical suspicion of its benefits. We report a second unique published instance of successful use of therapeutic hypothermia in the setting of cocaine-induced cardiac arrest.