We report a case of accidental severe hypothermia from cold exposure in a 31-month-old girl. The rectal temperature was 14.2 degrees C on presentation, and was accompanied by cardiac arrest. Other ominous laboratory markers for poor prognosis were also present. The child was successfully rewarmed by median sternotomy and full cardiopulmonary bypass. An amputation of one leg was required, but neurologic recovery was full. We emphasize the importance of timely, aggressive management in victims of severe hypothermia because of the tremendous potential for salvage despite catastrophic presentation.