Brain injury after cardiac arrest is one of the leading causes of morbidity and mortality, and effective neuroprotective strategies continue to represent a significant therapeutic challenge. Previous studies evaluating hypothermic targeted temperature management (TTM) have yielded inconsistent results. However, methodological limitations and selection bias in earlier trials may have reduced the generalizability of their findings. More recent evidence suggests that selected patients, particularly those with moderate hypoxic-ischemic brain injury, may derive benefit from hypothermic TTM, highlighting the importance of early identification of appropriate candidates. In addition, abandonment of hypothermic TTM may increase the incidence of post-resuscitation fever, which is associated with higher mortality and worse neurological outcomes. Therefore, individualized temperature management strategies based on patient characteristics and neurological status may be essential for optimizing outcomes after cardiac arrest. Therefore, the current trend advocates for an individualized strategy: selecting the target temperature based on the severity of neurological injury, initial cardiac rhythm, biomarkers, and electroencephalography, while emphasizing standardized implementation. In summary, the key to achieving benefit from hypothermic therapy lies in accurately identifying the beneficiary population and optimizing the quality of temperature management.