IV Epoprostenol Administration Challenges — EECC MCQ
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Correct answer: A — Epoprostenol requires a permanent tunnelled central venous catheter (e.g. Hickman line) with continuous infusion pump; risks include line infection/sepsis (most common serious complication), pump malfunction (causing abrupt drug withdrawal → rebound PH crisis), and catheter-related thrombosis
IV epoprostenol (prostacyclin, PGI2) is the most potent PAH-specific therapy, with proven survival benefit in severe PAH. However, its administration is complex: (1) continuous IV infusion via permanent tunnelled central line + portable infusion pump (carried 24/7); (2) very short half-life (~3-5 minutes) — abrupt interruption causes life-threatening rebound pulmonary hypertensive crisis (acute RV failure, syncope, death within minutes-hours); (3) catheter-related complications: line sepsis (most common serious adverse effect — 0.1-0.5 per patient-year), catheter thrombosis, line displacement; (4) drug side effects: flushing, jaw pain, headache, diarrhoea, leg pain; (5) dose titration: requires specialist PAH centre expertise. The 2022 ESC/ERS PH Guidelines recommend IV epoprostenol for: high-risk PAH (Class I) and refractory PAH. Alternative prostacyclin pathways: SC treprostinil (avoids central line), inhaled iloprost/treprostinil (less potent).
Reference: ESC/ERS (2022): PH Guidelines