Extracorporeal membrane oxygenation (ECMO) is a high-risk, low-frequency intervention requiring specialized training and effective teamwork, for which simulation-based training is a valuable tool. Across medical disciplines escape room-style simulations have been developed to enhance teamwork and engagement among learners.

We conducted a prospective observational study at a large academic medical center to evaluate the feasibility and educational impact of an escape room–style ECMO simulation. Thirty-seven nurses completed the escape room simulation. Teamwork was assessed with the Clinical Teamwork Scale (CTS), and effectiveness with the Simulation Effectiveness Tool (SET-M).

Observer-rated CTS scores for overall teamwork (r = −0.76), communication (r = −0.52), and decision-making (r = −0.55) correlated negatively with completion time, suggesting that stronger teamwork was associated with greater efficiency. Participant self-ratings were significantly higher than observer ratings across most domains (p < 0.01), and showed positive correlations with completion times. SET-M results indicated high satisfaction, with all participants reporting improved ECMO knowledge and skills, though prebriefing and debriefing received lower ratings.

These findings support escape room–style simulations as a feasible and engaging approach to ECMO education, with external observation playing a key role in assessing teamwork. Future studies should focus on structured briefing, randomized team assignments, and multidisciplinary cohorts to enhance generalizability and learning outcomes.