Introduction: Therapeutic hypothermia is a guideline-recommended treatment for certain unresponsive patients after a cardiac arrest. However, the degree to which patients with cardiac arrest have access to this therapy on a national level is unknown. Understanding hospital- and patient-level factors associated with receipt of hypothermia could inform interventions to improve access to this treatment among appropriate patients.Methods: This was a retrospective analysis using National Inpatient Sample data from 2016-2019. We used ICD10 diagnosis and procedure codes to identify adult patients with in-hospital and out-of-hospital cardiac arrest and receipt of therapeutic hypothermia. We used logistic regression with GEE clustering on hospital-year, and controlling for medical comorbidities, to evaluate patient and hospital factors associated with receiving therapeutic hypothermia.Results: We identified 478,419 patients (unweighted) with cardiac arrest. Of those, 4088 (0.85%) received therapeutic hypothermia. There was significant regional variation in hypothermia capabilities (Figure 1). At the patient level, age > 74 (OR: 0.54, p<0.001), female gender (OR: 0.89, p>0.001) and Hispanic race (OR: 0.69, p<0.001) were all associated with decreased odds of receiving hypothermia. Compared to patients with private insurance, patients with Medicare (OR: 0.73, p<0.001) and Medicaid (OR: 0.88, p=0.013) were less likely to receive hypothermia. Patients with shockable rhythms were less likely to receive hypothermia than those with non-shockable rhythms (OR: 0.85, p<0.001).Conclusions: Therapeutic hypothermia is rarely utilized after cardiac arrest and there is substantial regional variation in its use. Advanced age, female gender, Hispanic race, Medicare or Medicaid insurance, and shockable rhythm are all associated with a decreased likelihood of receiving hypothermia.