A case of cardiopulmonary arrest due to accidental hypothermia and its successful therapy is described. A 46-year-old man with deep accidental hypothermia (25.3 degrees C esophageal) was found outside showing respiratory and cardiac arrest. Resuscitation was immediately started and continuously performed during the transport to the University Hospital of Rostock, where a treatment with extracorporeal circulation was possible. After cardiopulmonary resuscitation for 120 minutes, the patient could finally be connected to the extracorporeal circulation. Over a period of 130 minutes the patient could be rewarmed up to a body temperature of 36.0 degrees C. The following therapy was complicated by the development of an alcoholic delirium, which was treated by clomethiazol, droperidol and clonidin infusion. After seven days of intensive therapy, he recovered completely and could be transferred from the intensive care unit to the department of psychiatry without neurological deficits showing only healing of frostbite of the feet. Based on this case report, the use of extracorporeal circulation for adequate rewarming in combination with cardiopulmonary resuscitation is described. Compared to other therapeutic measures such as peritoneal dialysis or veno-venous haemofiltration treatment with extracorporeal circulation is the method of choice.