Risks of carbon dioxide release from FFP packed with dry ice

A colleague in Saudi Arabia reported in 2003 that they shipped frozen units of FFP up to 400 kilometers by road in a hot climate to sister hospitals under their service contract. This is done with dry ice in styrofoam boxes sealed with tape. Due to the climate the boxes are not put in the trunk but reside beside the driver in the AC cooled cabin using recycled air position of AC. The temperature within the shipment is monitored continuously by electronic equipment throughout the passage and a temperature curve is printed for records. The Saudi Arabian colleague's only concern is that maybe the leakage of CO2 from the box may be sufficient to sometimes endanger the driver. He wonders if anyone would have data that could be of interest in this regard.

In response to the above query, a colleague in Southern California who claims experience with making CO2 blocks from compressed gas said he has noticed that people start to breath heavily (because their blood was over-saturated with CO2 and they needed more O2) when they are in close contact with the dry ice. The good news is that this intoxication is not like CO which is silent until you just pass out. Apparently, with CO2 exposure, one would start to find it hard to get enough oxygen and start to breath more quickly as a warning for excess CO2.

Editor's Note: Have other colleagues had a similar experience when in close contact with dry ice? Here is a link that might be worth checking out:

• The Toxic Emergency: Carbon Dioxide Poisoning. Emerg Med 32(05):36-38, 2000.

The following responses have been received.

1. A colleague comments that his experience draws, not from dry ice exposure, but from years of SCUBA diving in an environment where air conservation is important, rebreathing of unscrubbed (unpurified) exhaled air will also cause carbon dioxide buildup. A primary and nearly disabling symptom in some people is intense headache, to the point of nausea. It usually clears in few minutes from normal deep breathing of regular air. This is not on a blood banking point, but additional clinical information.
   
   
2. A Northern California colleague thinks that there is an easy solution to our Saudi Arabian colleague's concern about evaporating dry ice and the emission of CO2. First of all the boxes are sealed with tape. This will not prevent the CO2 from escaping but it certainly will slow down the process. The Northern Californian suspects that the box fills with CO2 before the CO2 starts to escape from the box. Pressure will need to build up in the box forcing out the CO2. If this is true a very large box to product ratio would help to insure minimal escape of CO2. Another solution would be to have the driver stop every 30 minutes and get out of the truck. Just getting in and out of the truck should cause some influx of fresh air. If the driver stands outside for 3 minutes his O2 saturation levels should revert back towards normal. Certainly, if the driver is complying with any SOP's, then it should be stated in one of the SOPs that if the driver notices that he is starting to hyperventilate, he should get out of the truck immediately and stay out of the truck until well after the hyperventilation stops. About five years ago the Northern Californian experienced hyperventilating because of diabetic ketoacidosis and comments "Hyperventilation gets your attention!!!".

ADDENDA Mar. 29, 2003

3. A colleague in Virginia reports that when they started getting shipments of FFP packaged in dry ice, she had an adverse reaction to the released CO2 after several boxes were opened. She mentions that she has asthma and that after having had that initial CO2 exposure got very dizzy and had to leave the room for several minutes. Now she only has one box containing dry ice opened at a time, and takes a break between opening boxes. Others in the department do not appear to be as affected as she is.

ADDENDA Dec. 22, 2004

4. A transfusion medicine physician in Turkey reports that his University Hospital in Istanbul has been warned against using frozen CO2 (dry ice) as a backup for freezers in which they store FFP. He wonders if there is any delerious effect on the FFP from using frozen CO2 as a back-up for their FFP storage freezers.
   
   Editor's note: The announcement by the FDA (MMWR, Dec 24, 2004) supports the need to provide adequate ventilation to avoid a potential risk of using frozen CO2 (dry ice) as a back up for FFP storage freezers, in that individuals in the vicinity of large quantities of dry ice might suffer hypoxia and hypoxemia if there is inadequate ventilation. The webmaster is unaware of data that suggest CO2 gas might cause spoilage of FFP. Comments from colleagues are encouraged.

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Ira A. Shulman, MD
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