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Unintentional hypothermia (core temperature < 36 °C) is a common side effect in patients undergoing surgery. Several patient-centred and external factors, e.g., drugs, comorbidities, trauma, environmental temperature, type of anaesthesia, as well as extent and duration of surgery, influence core temperature. Perioperative hypothermia has negative effects on coagulation, blood loss and transfusion requirements, metabolization of drugs, surgical site infections, and discharge from the post-anaesthesia care unit. Therefore, active temperature management is required in the pre-, intra-, and postoperative period to diminish the risks of perioperative hypothermia. Temperature measurement should be done with accurate and continuous probes. Perioperative temperature management includes a bundle of warming tools adapted to individual needs and local circumstances. Warming blankets and mattresses as well as the administration of properly warmed infusions via dedicated devices are important for this purpose. Temperature management should follow checklists and be individualized to the patient’s requirements and the local possibilities.

Accidental hypothermia is an unintentional drop of core temperature below 35 °C. Annually, thousands die of primary hypothermia and an unknown number die of secondary hypothermia worldwide. Hypothermia can be expected in emergency patients in the prehospital phase. Injured and intoxicated patients cool quickly even in subtropical regions. Preventive measures are important to avoid hypothermia or cooling in ill or injured patients. Diagnosis and assessment of the risk of cardiac arrest are based on clinical signs and core temperature measurement when available. Hypothermic patients with risk factors for imminent cardiac arrest (temperature < 30 °C in young and healthy patients and <32 °C in elderly persons, or patients with multiple comorbidities), ventricular dysrhythmias, or systolic blood pressure < 90 mmHg) and hypothermic patients who are already in cardiac arrest, should be transferred directly to an extracorporeal life support (ECLS) centre. If a hypothermic patient arrests, continuous cardiopulmonary resuscitation (CPR) should be performed. In hypothermic patients, the chances of survival and good neurological outcome are higher than for normothermic patients for witnessed, unwitnessed and asystolic cardiac arrest. Mechanical CPR devices should be used for prolonged rescue, if available. In severely hypothermic patients in cardiac arrest, if continuous or mechanical CPR is not possible, intermittent CPR should be used. Rewarming can be accomplished by passive and active techniques. Most often, passive and active external techniques are used. Only in patients with refractory hypothermia or cardiac arrest are internal rewarming techniques required. ECLS rewarming should be performed with extracorporeal membrane oxygenation (ECMO). A post-resuscitation care bundle should complement treatment.

Background Autoresuscitation describes the return of spontaneous circulation after termination of resuscitation (TOR) following cardiac arrest (CA). We aimed to identify phenomena that may lead to autoresuscitation and to provide guidance to reduce the likelihood of it occurring. Materials and methods We conducted a literature search (Google Scholar, MEDLINE, PubMed) and a scoping review according to PRISMA-ScR guidelines of autoresuscitation cases where patients undergoing CPR recovered circulation spontaneously after TOR with the following criteria: 1) CA from any cause; 2) CPR for any length of time; 3) A point was reached when it was felt that the patient had died; 4) Staff declared the patient dead and stood back. No further interventions took place; 5) Later, vital signs were observed. 6) Vital signs were sustained for more than a few seconds, such that staff had to resume active care. Results Sixty-five patients with ROSC after TOR were identified in 53 articles (1982–2018), 18 (28%) made a full recovery. Conclusions Almost a third made a full recovery after autoresuscitation. The following reasons for and recommendations to avoid autoresuscitation can be proposed: 1) In asystole with no reversible causes, resuscitation efforts should be continued for at least 20 min; 2) CPR should not be abandoned immediately after unsuccessful defibrillation, as transient asystole can occur after defibrillation; 3) Excessive ventilation during CPR may cause hyperinflation and should be avoided; 4) In refractory CA, resuscitation should not be terminated in the presence of any potentially-treatable cardiac rhythm; 5) After TOR, the casualty should be observed continuously and ECG monitored for at least 10 min.

Throughout history, accidental hypothermia has accompanied natural disasters in cold, temperate, and even subtropical regions. We conducted a non-systematic review of the causes and means of preventing accidental hypothermia after natural disasters caused by avalanches, earthquakes, tsunamis, and floods. Before a disaster occurs, preventive measures are required, such as accurate disaster risk analysis for given areas, hazard mapping and warning, protecting existing structures within hazard zones to the greatest extent possible, building structures outside hazard zones, and organising rapid and effective rescue. After the event, post hoc analyses of failures, and implementation of corrective actions will reduce the risk of accidental hypothermia in future disasters.

To elucidate patterns of and risk factors for acute traumatic injuries in climbers in need of professional rescue, a retrospective evaluation was performed of the Austrian National Registry of Mountain Accidents regarding rock climbing incidents over a 13-year timeframe from 2005 to 2018. From 2992 recorded incidents, 1469 were uninjured but in need of recovery, mainly when alpine climbing. Acute traumatic injuries (n = 1217) were often classified as severe (UIAA ≥ 3; n = 709), and commonly involved fractures (n = 566). Main injury causes were falls (n = 894) frequently preceded by rockfall (n = 229), a stumble (n = 146), a grip or foothold break-out (n = 143), or a belaying error (n = 138). In fatal cases (n = 140), multiple trauma (n = 105) or head injuries (n = 56) were most common, whereas lower extremity injuries (n = 357) were most common in severely injured patients. The risk for severe or fatal injuries increased with age and fall height when ascending or bouldering, during the morning hours, and when climbing without a helmet or rope. The case fatality rate was 4.7%, and the estimated total mortality rate was 0.003–0.007 per 1000 h of rock climbing. Acute traumatic injuries requiring professional rescue when rock climbing are often severe or fatal. Consequent use of a helmet when sport climbing, consistent use of a rope (particularly when ascending), proper spotting when bouldering, and proper training, as well as high vigilance when belaying are likely to help prevent such injuries.

Currently, healthcare management fosters a maximization of performance despite a relative shortage of specialists. We evaluated anaesthesiologists' workload, physical health, emotional well-being, job satisfaction and working conditions under increased pressure from consolidated working hours. A nationwide cross-sectional survey was performed in Austrian anaesthesiologists (overall response rate 41.0%). Three hundred and ninety four anaesthesiologists (280 specialists, 114 anaesthesiology trainees) participated. Anaesthesiologists reported frequently working under time pressure (95%CI: 65.6-74.6), at high working speed (95%CI: 57.6-67.1), with delayed or cancelled breaks (95%CI: 54.5-64.1), and with frequent overtime (95%CI: 42.6-52.4). Perceived work climate correlated with task conduct (manner of work accomplishment, the way in which tasks were completed), participation (decision-making power in joint consultation and teamwork), psychosocial resources, uncertainty, task variability and time tolerance (authority in time management and control over operating speed) (all P <0.001). Having not enough time for oneself (95%CI: 47.6-57.4), for sleep (95%CI: 45.6-55.4) or for one's partner and children (95%CI: 21.8-30.4) was common. One-third of the participants reported frequent feelings of being unsettled (95%CI: 33.4-43.0) and difficulty talking about their emotions (95%CI: 27.3-36.5). Frequent dissatisfaction with life was reported by 11.4% (95%CI: 8.7-14.9) of the respondents. Strong time pressure and little decision-making authority during work along with long working hours and frequent work interruptions constitute the basis for occupational stress in anaesthesiologists. We conclude that increased pressure to perform during work hours contributes to emotional exhaustion and poor work-life balance. Changes in the work schedule of anaesthesiologists are required to avoid negative effects on health and emotional well-being.

Background Although a gender gap in anesthesiology articles has been reported in certain subsets of anesthesiology literature, a comprehensive analysis is still lacking. Our objective was to conduct a scientometric analysis of the evolution of gender equity among anesthesiology authors worldwide, including all available affiliations. We hypothesized that gender inequity has diminished over time, with relevant differences among countries. Methods The MEDLINE/PubMed 2024 Baseline Repository was queried for all articles whose authors were affiliated with a department of anesthesiology. Author positions were sequenced into first, co-authors, and senior authors. Gender was inferred using online classification tools (genderize.io and gender-api.com). Geolocation was identified through text mining of the first author’s affiliation. The primary endpoint was the evolution of female authors from 1987 to 2023, calculated descriptively and by average annual growth rates. Secondary endpoints included the proportion of female authors in first or senior author position, the influence of senior authors’ gender on first authors’ gender, geographical differences, and future projections of parity (defined as 50% female authors). Results Among 374,301 anesthesiology articles and 7,574 journals, the proportion of female authors increased from 13.6% (1987) to 34.3% (2023) with an average annual growth of 0.57% (95%-confidence interval 0.38% − 0.77%). First authors were female in 30.0% and senior authors in 20.7%, with increases from 11.7% (1987) to 36.9% (2023), and from 11.0% (1987) to 25.9% (2023), respectively. Female authors were overall more likely to be first authors when the senior author was also female. In 2023, only Thailand and Portugal had a percentage of female authors over 50%. Tunisia achieved the highest average annual growth rate of female authors at 2.28% (95%-CI 1.51% − 3.06%). Based on the assumption that current trends continue unchanged, overall gender parity is estimated to be achieved by 2050, for first authors by 2043 and for senior authors by 2072. Conclusions Despite an increase in recent decades, women are still underrepresented as authors in academic anesthesiology, particularly in leading authorship positions. While relevant differences between countries exist, strategies addressing this gender gap at a country-specific level are needed to promote female authorship in academic anesthesiology.

If other conditions impair consciousness, such as asphyxia, intoxication, high altitude cerebral oedema or trauma, this regional modification to the Revised Swiss System may falsely predict a higher risk of cardiac arrest due to hypothermia. Caution should be taken if a patient remains “alert”, “confused” or “verbal” while showing signs of haemodynamic or respiratory instability such as bradycardia, bradypnoea, or hypotension because this may suggest transition to a stage with higher risk of cardiac arrest The main concepts of the RSS, using conscious level as the primary element to achieve staging and the stages being defined using the risk of HCA rather than core temperature ranges, were reaffirmed in the study by Barrow et al. Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: the HOPE score.

ObjectivesTo elucidate gender differences in snowboarding accidents.DesignRetrospective registry analysis within the Austrian National Registry of Mountain Accidents.SettingSnowboard-related emergencies between November 2005 and October 2018.ParticipantsAll injured snowboarders with documented injury severity and gender (3536 men; 2155 women).Primary and secondary outcome measuresGender-specific analysis of emergency characteristics and injury patterns.ResultsOver time, the number of mild, severe and fatal injuries per season decreased in men but not in women. Accidents most frequently were interindividual collisions (>80%) and occurred when heading downhill on a slope. Men more often suffered injuries to the shoulder (15.1% vs 9.2%) and chest (6.8% vs 4.4%), were involved in accidents caused by falling (12.9% vs 9.6%) or obstacle impact (4.3% vs 1.5%), while on slopes with higher difficulty levels (red: 42.6% vs 39.9%; black: 4.2% vs 2.5%), while snowboarding in a park (4.8% vs 2.1%) and under the influence of alcohol (1.6% vs 0.5%). Women more often sustained injuries to the back (10.2% vs 13.1%) and pelvis (2.9% vs 4.2%), on easier slopes (blue: 46.1% vs 52.4%) and while standing or sitting (11.0% vs 15.8%). Mild injuries were more frequent in women (48.6% vs 56.4%), severe and fatal injuries in men (36.0% vs 29.7% and 0.9% vs 0.4%). Male gender, age and the use of a helmet were risk factors for the combined outcome of severe or fatal injuries (OR (99% CI): 1.22 (1.00 to 1.48), 1.02 (1.02 to 1.03) and 1.31 (1.05 to 1.63)). When wearing a helmet, the relative risk (RR) for severe injuries increased while that for mild injuries decreased in male snowboarders only (RR (95% CI): 1.21 (1.09 to 1.34) and 0.88 (0.83 to 0.95)).ConclusionsSnowboard injuries are proportionally increasing in women and the observed injury patterns and emergency characteristics differ substantially from those of men. Further gender-specific research in snowboard-related injuries should be encouraged.Trial registration numberNCT03755050.