England enter the last-chance saloon on Thursday knowing defeat to West Indies will bring an inglorious end to their World Cup campaign.
Shock defeats to Ireland and Bangladesh have left Andrew Strauss' men teetering on the brink of an early departure from the 50-over showpiece.
England have not reached the knockout phase of a World Cup since 1996 when they lost to eventual winners Sri Lanka in the quarter-finals.
And, if another chapter of one-day woe is to be avoided, victory over West Indies is an absolute must.
That would likely be enough for England to advance to the last eight - although they could win and still miss out if Bangladesh beat South Africa on Saturday and West Indies round off Group B with victory over India. In that scenario, the final qualification place would be decided between England and India on net run-rate.
The last few days have seen a stomach bug sweeping through the camp, causing captain Andrew Strauss and spinner Graeme Swann to miss training on Tuesday, and paceman Ajmal Shahzad on Wednesday.
Shahzad's illness could lead to a reprieve for James Anderson, who has just four wickets and an economy rate of 6.56 at the tournament and was in danger of being dropped for Chris Tremlett.
"Tremlett has been waiting on the sidelines for quite a long time and offers something different with his height and his bounce," Strauss told Sky Sports.
"But Jimmy is a very solid performer for us and has been for a long time.
"Those are the sort of issues you have to look at when selecting your side."
England must also decide how many spinners to play - most recently Swann operated as the lone slow bowler against Bangladesh in Chittagong.
The Chennai pitch, which England have already experienced first hand during their low-scoring win over South Africa, will be the decisive factor in a possible Michael Yardy recall or first outing for James Tredwell.
The other selection decision is whether to stick with Matt Prior as Strauss' opening partner or reshuffle the middle-order to promote Ian Bell or Ravi Bopara to the top.
West Indies, who also need a victory to confirm their place in the last eight, are boosted by the return to fitness of Chris Gayle after he missed the win over Ireland last time out with an abdominal strain.
Gayle bolsters an already power-laden batting line-up, which has benefited from the elevation of Kieron Pollard following Dwayne Bravo's tournament-ending knee injury.
"He (Pollard) has been pushed up in Dwayne Bravo's absence and has been in good form," said skipper Darren Sammy. "It is all about finding the right place for him to bat in the 11.
"He has taken responsibility and it has paid off. We expect him to continue in the same vein."
England have won the last four completed ODIs between the two countries and have not lost to West Indies at the World Cup since the 1979 final.