Abstract : Hypoxic–ischemic brain injury remains the leading cause of death and unfavorable neurological outcome in patients successfully resuscitated after cardiac arrest. Therapeutic hypothermia was introduced as a neuroprotective intervention aimed at limiting secondary brain injury during the post–cardiac arrest period. Early randomized clinical trials demonstrated improved neurological outcomes in comatose survivors treated with mild hypothermia, leading to widespread adoption of this strategy in intensive care units worldwide. However, over the last decade, emerging evidence from large randomized trials and contemporary meta-analyses has challenged the routine use of deep hypothermia, particularly when compared with strategies focused on strict temperature control and prevention of hyperthermia. Updated international guidelines now emphasize individualized temperature management rather than universal cooling to predefined targets. This narrative review summarizes current knowledge on the pathophysiology of post–cardiac arrest brain injury, the biological rationale for hypothermia-induced neuroprotection, and the evolution of clinical evidence regarding temperature management strategies. Contemporary guideline recommendations, practical aspects of clinical implementation, and limitations of therapeutic hypothermia are discussed. Current data suggest that routine induction of hypothermia at 33°C does not provide a clear survival or neurological advantage over active normothermia with effective fever prevention. Strict temperature control remains a cornerstone of post–cardiac arrest care, while optimal target temperature should be individualized based on patient characteristics and institutional expertise.