Hypothermic patient in cardiac arrest don't present to our Emergency Departments every day, but chances are we will all take care of one of these patients in our career. The decisions involved in evaluation and management of this group of patients differs significantly from those of most other patients that present in cardiac arrest. We will discuss the decision whether or not to continue resuscitation for patients in hypothermic cardiac arrest until they are "warm and dead," how the code management his similar and different from that of a normothermic patient and the indications and contraindications to ECMO (including when to transfer for ECMO.)