background Hypothermia is clinically defined as a drop in core body temperature below 35°C in a previously healthy individual in the absence of pre-existing inherent underlying thermoregulatory pathology. Classification of hypothermia below 35°C is described as mild (32°C to 35°C) and moderate (28°C to 32°C). A temperature below 28°C is classified as severe. At 28°C cardiopulmonary function is likely to become compromised. The myocardium becomes vulnerable to arrhythmia, ventricular asystole and subsequently complete cardiovascular collapse. Concomitant cognitive impairment is most commonly associated with severe hypothermia and cold injury. These patients tend to be individuals with mental illness, homelessness, and alcohol and illicit drug use. Recreational accidents such as skiing comprise the second most common group for hypothermic injury.1 There has been much academic debate and speculation regarding the optimal approach to rewarming any patient suffering from hypothermia.2 Mild hypothermia responds well to external rewarming techniques like forced heated air blankets.3 Moderate hypothermia is more precarious from a physiological standpoint. The myocardium is exceptionally vulnerable at these temperatures. Consequently, rapid rewarming techniques are favoured. This includes warmed intravenous (IV) fluids and warm peritoneal lavage in those who have not demonstrated overt signs of cardiac instability.4 Less commonly, these modalities can be augmented with airway warming and pleural irrigation.4,5 If patients with severe hypothermia have a sustainable cardiac rhythm, they are at increased risk for cardiovascular collapse.6 The optimal modality for rewarming a patient with severe hypothermic cardiac arrest remains a highly controversial topic.7 The most recent retrospective comparative study in 68 patients demonstrated cardiopulmonary bypass (CPB) rewarming to be far superior to conventional methods of rewarming, with mortality rates of 15.8% and 53.3%, respectively. Reanimation on CPB allows for several advantages, including rapid rewarming, but most importantly oxygenation and perfusion are preserved. A retrospective study analyzed the long-term neurological outcomes of survivors who reported normal neuropsychological findings in 93.3% of cases and normal brain magnetic resonance imaging in 86.7% of cases.8