Despite recent advances, care of the post–cardiac arrest patient remains a challenge. In this article, the authors discuss an approach to the initial care of post–cardiac arrest patients with particular focus on targeted temperature management (TTM). The article starts with history, physiologic rationale, and the major randomized controlled trials that have shaped guidelines for post–cardiac arrest care. It also reviews controversial topics, including TTM for nonshockable rhythms, TTM dose, and surface versus endovascular cooling. The article concludes with a brief review of other key aspects of post–arrest care: coronary angiography, hemodynamic optimization, ventilator management, and prognostication.