Current artificial lungs and respiratory assist devices designed for carbon dioxide removal (CO2R) are limited in their efficiency due to the relatively small partial pressure difference across gas exchange membranes. To offset this underlying diffusional challenge, bioactive hollow fiber membranes (HFMs) increase the carbon dioxide diffusional gradient through the immobilized enzyme carbonic anhydrase (CA), which converts bicarbonate to CO2 directly at the HFM surface. In this study, we tested the impact of CA-immobilization on HFM CO2 removal efficiency and thromboresistance in blood. Fiber surface modification with radio frequency glow discharge (RFGD) introduced hydroxyl groups, which were activated by 1 M CNBr while 1.5 M TEA was added drop wise over the activation time course, then incubation with a CA solution covalently linked the enzyme to the surface. The bioactive HFMs were then potted in a model gas exchange device (0.0084 m(2)) and tested in a recirculation loop with a CO2 inlet of 50 mmHg under steady blood flow. Using an esterase activity assay, CNBr chemistry with TEA resulted in 0.99 U of enzyme activity, a 3.3 fold increase in immobilized CA activity compared to our previous method. These bioactive HFMs demonstrated 108 mL/min/m(2) CO2 removal rate, marking a 36% increase compared to unmodified HFMs (p < 0.001). Thromboresistance of CA-modified HFMs was assessed in terms of adherent platelets on surfaces by using lactate dehydrogenase (LDH) assay as well as scanning electron microscopy (SEM) analysis. Results indicated HFMs with CA modification had 95% less platelet deposition compared to unmodified HFM (p < 0.01). Overall these findings revealed increased CO2 removal can be realized through bioactive HFMs, enabling a next generation of more efficient CO2 removal intravascular and paracorporeal respiratory assist devices. (C) 2012 Elsevier B.V. All rights reserved.