Simulation-based education (SBE) in health care is expanding in both scope and relevance. As on-the-job training is challenging in extracorporeal membrane oxygenation (ECMO), SBE features strongly in its curricula, yet little is known regarding its efficacy. We searched 4 databases through May 13, 2022 and conducted a narrative synthesis of 28 studies investigating SBE in ECMO. Notably, there were no standardized SBE ECMO curricula among studies. Nonetheless, taken together, these articles suggest that simulation improves competency scores, confidence, teamwork, troubleshooting emergencies, and times to critical actions and cannulation. Though the reporting of SBE in ECMO is heterogeneous, simulation may be comparable to, or more effective than, conventional training methods. Retention of knowledge and skills over time remains unclear though regular simulation training may be beneficial. There is a need to establish standardized ECMO curricula, of which SBE should be a core component.