Temperature management plays a critical role in the neurological recovery of cardiac arrest survivors. While advanced device-based temperature control systems are prevalent in high-resource settings, their implementation in low-resource environments remains a challenge. This study aimed to examine the impact of fever prevention on neurological outcomes in cardiac arrest survivors managed without device-based temperature control. We conducted a retrospective study of adult in-hospital cardiac arrest survivors at an academic institution from 2013 to 2020. Patients were included if they were ≥18 years old, survived for at least 72 hours post-return of spontaneous circulation (ROSC), and experienced cardiac arrest in inpatient wards, intensive care units, or the emergency department. Fever was defined as a rectal temperature ≥37.5°C, and neurological outcomes were assessed using the Cerebral Performance Category (CPC) scale at 1 month post-ROSC. A good neurological outcome was defined as CPC 1 or 2. Statistical analyses included chi-square tests and logistic regression to identify predictors of outcomes. Of the 427 patients included, 58.8% experienced fever, and 12.8% achieved a good neurological outcome. Patients with fever were significantly less likely to have favorable outcomes (p < 0.01). Logistic regression revealed that each 1°C increase in body temperature beyond 37.5°C was associated with a 31% reduction in the likelihood of a good outcome (p < 0.01). Other predictors of poor outcomes included prolonged low-flow states and higher pre-arrest frailty scores. Fever is strongly associated with poor neurological outcomes in cardiac arrest survivors, particularly in low-resource settings without device-based temperature management. Effective fever prevention strategies, such as intravenous antipyretics and physical cooling methods, should be prioritized to improve outcomes.