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A retrospective analysis was performed to estimate the practicability of a pumpless extracorporeal lung assist system (pECLA) in trauma patients suffering from severe brain injury and the acute respiratory distress syndrome (ARDS).Five patients with acute severe brain injury and ARDS, ventilated in a lung protective mode, were connected to pECLA to avoid the detrimental effects of hypercapnia on intracranial pressure (ICP) and cerebral outcome.With pECLA, hypercapnia was eliminated in all patients, and the minute volume of artificial ventilation could be reduced. Subsequently, ICP was reduced, and systemic hemodynamics and cerebral perfusion pressure remained stable. One patient died of multiple-organ failure as a consequence of multiple-trauma. The remaining patients survived with good neurologic function.pECLA is a promising alternative to conventional pump-driven systems for patients with ARDS and brain injury, since the pECLA system has minor restrictions, limitations, and side effects.