Reanalysis output for 1948-99 is used to evaluate the temporal distributions, the geographical origins, and the atmospheric teleconnections associated with major cold outbreaks affecting heavily populated areas of middle latitudes. The study focuses on three subregions of the United States and two subregions of Europe. The cold outbreaks affecting the United States are more extreme than those affecting Europe, in terms of both the regionally averaged and the local minimum air temperatures. There is no apparent trend toward fewer extreme cold events on either continent over the 1948-99 period, although a long station history suggests that such events may have been more frequent in the United States during the late 1800s and early 1900s. The trajectories of the coldest air masses are southward or southeastward over North America, but westward over Europe. Subsidence of several hundred millibars is typical of the trajectories of the coldest air to reach the surface in the affected regions. Sea level pressure anomalies evolve consistently with the trajectories over the 1-2 weeks prior to the extreme outbreaks, and precursors of the cold events are apparent in coherent antecedent anomaly patterns. Negative values of the North Atlantic oscillation index and positive anomalies of Arctic sea level pressure are features common to North American as well as European outbreaks. However, the strongest associated antecedent anomalies of sea level pressure are generally shifted geographically relative to the nodal locations of the North Atlantic and Arctic oscillations.