BACKGROUND The aim of this study was to investigate the use of therapeutic hypothermia (TH) in Italian Intensive Care Units (ICUs). METHODS METHODS After being contacted by phone, a structured questionnaire to evaluate the use of TH was sent to all Italian ICUs. The questionnaire was aimed at determining the extent of TH use (indications, methods employed, target temperature, side effects) as well as the reasons why some ICUs did not make use of TH for the treatment of cardiac arrest patients. RESULTS Out of the 448 ICUs contacted, 90% (n=404) returned the questionnaire completely filled in. Sixty-six responders (16%) made use of TH for post-resuscitation care, and 4% used TH for other clinical scenarios (10 ICUs for traumatic brain injury; 5 ICUs for other reasons). More than half used TH not only for cardiac arrest subsequent to ventricular fibrillation (VF), but also for non-VF cardiac arrest with the duration of TH treatment being within the time suggested by advanced cardiac life support guidelines. On the other hand, 80% of questionnaire responders did not use TH, mainly because they felt they did not have enough data/experience (45%), or simply because they had never thought about it (18%). CONCLUSIONS Despite authoritative data supporting its effectiveness and safety, use of TH as part of the therapy in a post-resuscitation period in Italian ICUs remains low. The reasons for not using it are not completely justified and suggest that an educational program is advisable in order to boost the utilization of TH in Italy.