Background: The implementation of extracorporeal membrane oxygenation (ECMO) in patients with hematologic malignancies suffering from severe acute respiratory distress syndrome (ARDS) and multiple organ failure (MOF) remains controversial.

Case presentation: We present a case of a patient with acute monoblastic leukemia who exhibited rapid-onset MOF. Hemodynamic stability was achieved primarily with pharmacologic vasopressor therapy, followed by mechanical circulatory support via ECMO, in conjunction with a prompt chemotherapy session. The patient had evidence of disseminated intravascular coagulation (DIC) and deteriorating status, characterized by dilated and nonreactive pupils due to multiple hemorrhagic lesions and diffuse brain edema, resulting in a fatal outcome.

Conclusion: This case discusses the challenging decision-making process encountered by physicians in the intensive care unit, particularly with the withdrawal or withholding of treatment at the end of life within our legal framework. Current Croatian legislation remains inflexible and fails to correspond with developments in clinical practice and judgments regarding palliative care patients. To provide high-quality treatment to palliative and end-of-life patients, regulatory frameworks and regulations must create a secure environment for both healthcare providers and patients.