Successful cardiopulmonary resuscitation extends beyond the restoration of spontaneous circulation (ROSC), its ultimate goal is the preservation and recovery of neurological function. However, the overall benefit of hypothermia therapy following cardiopulmonary resuscitation remains uncertain, largely due to substantial patient heterogeneity. Consequently, targeted temperature management (TTM) may not be universally applicable to all patients achieving ROSC. Appropriate patient selection is therefore critical to optimizing the therapeutic efficacy of TTM, while careful prevention and management of treatment-related complications are equally important during temperature modulation. Precision temperature management guided by multimodal neurological monitoring may improve neurological outcomes and overall prognosis in selected ROSC patients. Nevertheless, the optimal implementation strategy for TTM following cardiac arrest continues to require further clinical investigation, refinement, and validation.