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Rationale: Preoperative poor physical fitness and respiratory muscle weakness are associated with postoperative pulmonary complications that result in prolonged hospital length of stay and increased mortality. Objectives: Examine the effect of preoperative exercise training on the risk of postoperative pulmonary complications across different surgical settings. Methods: We searched MEDLINE, Web of Science, Embase, Pedro, and the Cochrane Central Register, without language restrictions, for studies from inception to July, 2020. We included randomized controlled trials that compared patients receiving exercise training with those receiving usual care or sham training before cardiac, lung, esophageal, or abdominal surgery. Postoperative pulmonary complications were the main outcome; secondary outcomes were preoperative functional changes, postoperative mortality, cardiovascular complications and hospital length of stay. The study was registered with PROSPERO (N° CRD42018096956). Results: From 29 studies, 2'070 patients were pooled for meta-analysis. Compared to the control group, preoperative exercise training was associated with a lower incidence of postoperative pulmonary complications (23 studies, 1'864 patients, [RR] 0.52; 95% CI 0.41-0.66, grading of evidence: moderate); Trial Sequential Analysis confirmed effectiveness and there was no evidence of difference of effect across surgeries, type of training (respiratory muscles, endurance or combined) and preoperative duration of training. At the end of the preoperative period, exercise training resulted in increased peak oxygen uptake (weighted mean difference [WMD] +2 ml/kg/min, 99%CI 0.3 to 3.7) and higher maximal inspiratory pressure (WMD +12.2

Rationale: Preoperative poor physical fitness and respiratory muscle weakness are associated with postoperative pulmonary complications that result in prolonged hospital length of stay and increased mortality. Objectives: Examine the effect of preoperative exercise training on the risk of postoperative pulmonary complications across different surgical settings. Methods: We searched MEDLINE, Web of Science, Embase, Pedro, and the Cochrane Central Register, without language restrictions, for studies from inception to July, 2020. We included randomized controlled trials that compared patients receiving exercise training with those receiving usual care or sham training before cardiac, lung, esophageal, or abdominal surgery. Postoperative pulmonary complications were the main outcome; secondary outcomes were preoperative functional changes, postoperative mortality, cardiovascular complications and hospital length of stay. The study was registered with PROSPERO (N° CRD42018096956). Results: From 29 studies, 2'070 patients were pooled for meta-analysis. Compared to the control group, preoperative exercise training was associated with a lower incidence of postoperative pulmonary complications (23 studies, 1'864 patients, [RR] 0.52; 95% CI 0.41-0.66, grading of evidence: moderate); Trial Sequential Analysis confirmed effectiveness and there was no evidence of difference of effect across surgeries, type of training (respiratory muscles, endurance or combined) and preoperative duration of training. At the end of the preoperative period, exercise training resulted in increased peak oxygen uptake (weighted mean difference[WMD] +2 ml/kg/min, 99%CI 0.3 to 3.7) and higher maximal inspiratory pressure (WMD +12.2

Aim: The International Hypothermia Registry (IHR) was created to increase knowledge of accidental hypothermia, particularly to develop evidencebased guidelines and find reliable outcome predictors. The present study compares hypothermic patients with and without cardiac arrest included in the IHR. Methods: Demographic, pre-hospital and in-hospital data, method of rewarming and outcome data were collected anonymously in the IHR between 2010 and 2020. Results: Two hundred and one non-consecutive cases were included. The major causeof hypothermia was mountain accidents, predominantly in young men. Hypothermic Cardiac Arrest (HCA) occurred in 73 of 201 patients. Core temperature was significantly lower in the patients in cardiac arrest (25.0 vs. 30.0°C, p < 0.001). One hundred and fifteen patients were rewarmed externally (93% with ROSC), 53 by extra-corporeal life support (ECLS) (40% with ROSC) and 21 with invasive internal techniques (71% with ROSC). The overall survival rate was 95% for patients with preserved circulation and 36% for those in cardiac arrest. Witnessed cardiac arrest and ROSC before rewarming were positive outcome predictors, asphyxia, coagulopathy, high potassium and lactate negative outcome predictors. Conclusions: This first analysis of 201 IHR patients with moderate to severe accidental hypothermia shows an excellent 95% survival rate for patients with preserved circulation and 36% for HCA patients. Witnessed cardiac arrest, restoration of spontaneous circulation, low potassium and lactate and absence of asphyxia were positive survival predictors despite hypothermia in young, healthy adults after mountaineering accidents. However, accidental hypothermia is a heterogenous entity that should be considered in both treatment strategies and prognostication.

Between 2001 and 2015, in the EU and EFTA countries, the number of publications increased, whereas the number of original articles decreased. Germany published most, but Denmark had most publications per anaesthesiologist and per capita, and also achieved the highest impact factor per article.