The statement says the office has reviewed medical records and talked extensively with his treating physicians.
The University of Virginia student died Monday. Tony Kim and Kim Hak Song were arrested in recent months on charges of committing "hostile acts".
James Foley was a freelance war correspondent before he was captured and held for almost two years.
In addition to the external exam, the coroner's office reviewed his medical records from the University of Cincinnati Medical Center and AeroMed Management Group, the air ambulance service that helped evacuate him from Pyongyang, North Korea, where he had been detained for almost 17 months.
Warmbier's heartbroken family lashed out at the North Korean regime Monday, saying in a statement: "the bad torturous mistreatment our son received at the hands of the North Koreans ensured that no other outcome was possible beyond the sad one we experienced today".
Warmbier had been sentenced to 15 years of labor after being found guilty of trying to steal a propaganda poster from a hotel, during a January 2016 visit to North Korea's capital.
"All those that wish to join his family in celebrating his life are cordially invited", said the Spring Grove Cemetery and Arboretum. "It should never, ever be allowed to happen", said President Donald Trump. Moon expressed condolences to the Warmbier family and the American people. "We will continue to build on our relationship and the dialogue we've had with China". The US will "continue to work with them and others to put the appropriate pressure on North Korea to change the behavior of this regime", Spicer said.
North Korea must bear "heavy responsibility" for Warmbier's death, said South Korean President Moon Jae-in.
"Let us state the facts plainly: Otto Warmbier, an American citizen, was murdered by the Kim Jong-un regime", he said.
Senate Armed Services Committee Chairman John McCain, R-Ariz., left, confers with Sen.
Three Americans remain under DPRK detention.
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Suffering from severe brain damage, he died Monday in his hometown of Cincinnati, Ohio, surrounded by family who decried his "awful torturous mistreatment" at the hands of Pyongyang, while taking solace in the fact he made it home before he died.
"It's not uncommon to get autopsy objections", Justin Weber of the coroner's office told AFP.
Doctors caring for Warmbier said the 22-year-old was experiencing "unresponsive wakefulness," a term that has come to replace the "persistent vegetative state".
This story has been corrected to show the coroner's last name is Sammarco, not Sammaraco. Warmbier, an American college student who was released by North Korea in a com.
There is growing outrage over the death of Otto Warmbier.
Warmbier had planned to study in China in his third year of college and heard about Chinese travel companies offering trips to North Korea.
Warmbier's sophomore English teacher said he would be "dearly missed". Warmbier returned to the US last week after being imprisoned for 17 months in North Korea, but was revealed to be in a coma shortly after news of his release emerged.
Do you agree that Obama is responsible for the fate of Otto Warmbier?
Warmbier died Monday in OH, where he had been hospitalized since his June 13 release.
American student Otto Frederick Warmbier (C) arrives at a court for his trial in Pyongyang, on March 16, 2016.
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