The global increase of recreational escape rooms has inspired teachers around the world to implement escape rooms in educational settings. As escape rooms are increasingly popular in education, there is a need to evaluate their use, and a need for guidelines in order to develop and implement escape rooms in the classroom. This systematic review synthesizes current practices and experiences, focussing on important educational and game design aspects. Subsequently, relations between the game design aspects and the educational aspects are studied. Finally, student outcomes are related to the intended goals. In different disciplines, educators appear to have different motives to use aspects such as time constraints or teamwork. These educators make different choices for related game aspects such as the structuring of the puzzles. Other educators base their choices on common practices in recreational escape rooms. However, in educational escape rooms players need to reach the game goal by achieving the educational goals. More alignment in game mechanics and pedagogical approaches are recommended. These and more results lead to recommendations for developing and implementing escape rooms in education, and will help educators creating these new learning environments, and eventually help students’ foster knowledge and skills more effectively.