title: Long-term efficacy of pressure immobilization bandages in a porcine model of coral snake envenomation.
abstract: BACKGROUND
  Pressure immobilization bandages delay mortality for 8 hours after coral snake envenomation, but long-term efficacy has not been established.
  
  
  OBJECTIVE
  The objective of this study is to determine the long-term efficacy of pressure immobilization bandages after coral snake envenomation in the absence of antivenom therapy.
  
  
  METHODS
  A randomized, observational pilot study was conducted. Ten pigs (17.3-25.6 kg) were sedated, intubated for 5 hours, and injected subcutaneously with 10 mg of lyophilized Micrurus fulvius venom resuspended in water. Pigs were randomly assigned to a control group (no treatment) or a treatment group (compression bandage and splint) approximately 1 minute after envenomation. Bandage pressure was not controlled. Pigs were monitored daily for 21 days for signs of respiratory depression, decreased oxygen saturations, and paralysis. In case of respiratory depression, pigs were humanely euthanized and time to death recorded. Statistical analysis was performed with Fisher exact test, Mann-Whitney U test, and Kaplan-Meier survival curve as appropriate.
  
  
  RESULTS
  Median survival time of control animals was 307 minutes compared with 1172 minutes in treated animals (P = .10). Sixty percent of pigs in the treatment group survived to 24 hours vs 0% of control pigs (P = .08). Two of the treatment pigs survived to the end point of 21 days but showed necrosis of the distal lower extremity.
  
  
  CONCLUSIONS
  Long-term survival after coral snake envenomation is possible in the absence of antivenom with the use of pressure immobilization bandages. The applied pressure of the bandage is critical to allowing survival without necrosis. Future studies should be designed to accurately monitor the pressures applied.
authors: Department of Emergency Medicine, Brody School of Medicine at East Carolina University, Greenville NC.
authors: Mary E
authors: ME
authors: Smyrnioudis
authors: Department of Comparative Medicine, Brody School of Medicine at East Carolina University, Greenville NC.
authors: Dorcas P
authors: DP
authors: O'Rourke
authors: Department of Comparative Medicine, Brody School of Medicine at East Carolina University, Greenville NC.
authors: Matthew D
authors: MD
authors: Rosenbaum
authors: Department of Emergency Medicine, Brody School of Medicine at East Carolina University, Greenville NC.
authors: Kori L
authors: KL
authors: Brewer
authors: Department of Emergency Medicine, Brody School of Medicine at East Carolina University, Greenville NC. Electronic address: meggsw@ecu.edu.
authors: William J
authors: WJ
authors: Meggs
mesh_terms: D000818:Animals; D001458:Bandages; D004546:Elapid Venoms / Q000494:pharmacology; D017815:Elapidae; D005260:Female; D005552:Forelimb; D007103:Immobilization / Q000379:methods*; D010865:Pilot Projects; D011312:Pressure; D012909:Snake Bites / Q000628:therapy*; D016019:Survival Analysis; D013552:Swine; D013997:Time Factors
chemical_list: D004546:Elapid Venoms; C053972:micrurus venom