There is a tabletop rpg called Dread, a horror based game that when you do an action it requires a "pull" maybe 2 for something complex. There is (basically) a jenga tower in the middle of the table. When you make a pull, you take a block out and place it on top. Basically, the player who is the last one to touch the tower when it falls will have their character die. Obviously I couldn't request a pull per action, but some other less frequent qualifier would determine a pull. Maybe every in game hour or day or something? Not sure.

I think that since Curse of Strahd is a horror themed game, this might play in well. Essentially turning Strahd into a player killer. I just don't know if this would help or hurt the overall experience. Any thoughts?

You could have it force a pull on a critical fail, if you're feeling particularly cruel. Or else once per day you could have the party make some kind of saving throw, and the lowest has to make a pull. 

Oh I like that. And the saving throw idea makes me think this could go for out of the abyss also, the character that drops the tower completely descends into madness. Very interesting.....I would probably do critical failures and then lowest saving throw. Unless that is a little too high paced for what I'm wanting, then I might just do critical fails and hope no one is a halfling lol