Asphyxiation Due to Dry Ice in a Walk-in Freezer

Background: Exposure to a high concentration of environmental carbon dioxide (CO2) can result in poisoning through direct toxicity and by displacing atmospheric oxygen (O2). Dry ice undergoes sublimation to a gaseous state at −78.5°C (−109.3°F), which is heavier than air and can accumulate in dependent areas. Case Report: We report the case of a 59-year-old man found in cardiac arrest shortly after entering a recently repaired walk-in freezer that contained dry ice. First responders and bystanders did not recognize the proximate hazardous environment but were fortunately uninjured. A careful Emergency Department history coupled with rapid case investigation by the Medical Examiner's Office led to the determination of the cause of death and the elimination of the ongoing hazard. Conclusion: This case illustrates the lethal consequences of improper storage of dry ice and the need to consider toxic environmental exposure as a cause of sudden cardiac arrest.