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The exact time between bite and collapse was known for 149 people (median, 20\u2009min; interquartile range, 15\u201330\u2009min; range, 5\u2013115\u2009min); the time exceeded 60 minutes for only two people, each after releasing tight bandages 60 minutes after the bite. The collapse preceded hospital arrival in 132 cases (84%). Brown snake (<jats:italic>Pseudonaja<\/jats:italic> spp.) envenoming was the leading cause of collapse (103 cases, 66%). Forty\u2010two collapses (27%) were followed by cardiac arrest, 49 (31%) by seizures (33 without cardiac arrest), and five by apnoea; collapse was associated with hypotension in all 24 people whose blood pressure could be measured at or close to the time of collapse. Twenty\u2010five people who collapsed died (16%), and seven of the envenomed people who did not collapse (0.6%; difference: 15 percentage points; 95% confidence interval, 8\u201321 percentage points). The deaths of 21 of the 25 people who collapsed were immediately associated with the cardiac arrest that followed the collapse; three people who did not have cardiac arrests died later of intracranial haemorrhage, and one of hyperthermia. The proportion of people who had collapsed before reaching hospital was larger for people who died of post\u2010collapse cardiac arrest (13 of 21, 62%) than for those who survived (6 of 21, 28%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Collapse after Australian snake envenoming almost always occurred within 60 minutes of the bite, was always accompanied by VICC, and most frequently followed brown snake bites. Poorer outcomes, including cardiac arrest, seizures, and death, were more frequent for people who collapsed than for those who did not. Outcomes for people who collapsed before medical care arrived were poorer than for those who collapsed in hospital or in an ambulance.<\/jats:p><\/jats:sec>","DOI":"10.5694\/mja2.52622","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T00:57:39Z","timestamp":1741741059000},"page":"313-317","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Early cardiovascular collapse after envenoming by snakes in Australia, 2005\u20132020: an observational study (<scp>ASP<\/scp>\u201031)"],"prefix":"10.5694","volume":"222","author":[{"given":"Geoffrey K","family":"Isbister","sequence":"first","affiliation":[{"name":"The University of Sydney  Sydney NSW"},{"name":"The University of Newcastle  Newcastle NSW"},{"name":"NSW Poisons Information Centre Children's Hospital at Westmead  Sydney NSW"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine Z","family":"Isoardi","sequence":"additional","affiliation":[{"name":"NSW Poisons Information Centre Children's Hospital at Westmead  Sydney NSW"},{"name":"Princess Alexandra Hospital  Brisbane QLD"},{"name":"The University of Queensland  Brisbane QLD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0079-5056","authenticated-orcid":false,"given":"Angela L","family":"Chiew","sequence":"additional","affiliation":[{"name":"NSW Poisons Information Centre Children's Hospital at Westmead  Sydney NSW"},{"name":"Prince of Wales Hospital and Community Health Services  Sydney NSW"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shane","family":"Jenkins","sequence":"additional","affiliation":[{"name":"The University of Newcastle  Newcastle NSW"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6326-4711","authenticated-orcid":false,"given":"Nicholas A","family":"Buckley","sequence":"additional","affiliation":[{"name":"The University of Sydney  Sydney NSW"},{"name":"NSW Poisons Information Centre Children's Hospital at Westmead  Sydney NSW"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,3,9]]},"reference":[{"key":"e_1_2_6_1_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-022-33627-9"},{"key":"e_1_2_6_2_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2020-057926","article-title":"Managing snakebite","volume":"376","author":"Ralph R","year":"2022","journal-title":"BMJ"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja17.00094"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja12.11172"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0053188"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja11.11300"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.2009.tb02736.x"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2016.1250903"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEJ.0000000000000577"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13181-020-00776-6"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-019-56643-0"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxicon.2016.10.001"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X9101900304"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X0503300106"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxlet.2012.06.015"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxlet.2013.06.235"},{"key":"e_1_2_6_17_1","unstructured":"Coroners Court of New South Wales.Inquest into the death of Brent Justin Crough (2018\/10493). 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