Mathew Barzal scored 1:24 into the second overtime Saturday for the host New York Islanders, who avoided elimination in an Eastern Conference first-round series with a 3-2 win in Game 4 in Elmont, N.Y.
The Hurricanes lead the best-of-seven series three games to one.
Game 5 is scheduled for Tuesday night in Raleigh, N.C.
Barzal redirected Robert Bortuzzo's shot from the blue line for his second goal of the game. Jean-Gabriel Pageau scored in the third for the Islanders. Goaltender Semyon Varlamov made 42 saves.
Seth Jarvis scored in the first period for the Hurricanes and Stefan Noesen tied the score with 5:52 left in the third. Goalie Frederik Andersen recorded 32 saves.
The Islanders had four of the first six shots before forward Anders Lee was whistled for tripping at 7:16 to set up the power play that yielded Jarvis' goal 44 seconds later.
Varlamov got a glove on a slap shot by Brent Burns and the puck bounced off the skate of Islanders defenseman Adam Pelech before Hurricanes center Jake Guentzel got a stick on it. Jarvis collected the puck and fired a shot past a kneeling Ryan Pulock and over Varlamov's stick shoulder.
The Islanders had just seven shots in the 20-plus minutes following Lee's penalty before Barzal tied the score with 9:50 left in the second. Barzal took a pass from Pelech in the neutral zone and skated toward the Hurricanes' goal line, where he couldn't shake defenseman Brady Skjei. Barzal headed back above the right faceoff circle, whirled round to elude Skjei and fired a shot beyond the glove of Andersen.
Sebastian Aho was whistled for tripping in the waning seconds of the middle period, but the Islanders maintained possession of the puck until time expired so they could have a full power play to open the third. Lee won a faceoff deep in the Hurricanes' zone before Pageau put back the rebound of a shot by Noah Dobson at the 1:38 mark.
The teams traded empty power plays before the Islanders' Bortuzzo drew a hooking penalty with 6:26 left. Noesen tied the score 34 seconds later when he got a stick on Teuvo Teravainen's pass into the crease.
The Hurricanes outshot the Islanders 17-9 in the first overtime, though New York had the best scoring opportunity with a little under four minutes left. Kyle Palmieri couldn't finish a wraparound and Brock Nelson misfired on a rebound before Andersen stopped a point-blank shot by Hudson Fasching in the crease.
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