In order to raise global profiles of universities, governments around the world have pushed universities to offer English medium instruction (EMI) courses. While research examining the attitudes toward EMI has been conducted in various countries, these studies generally look at a single university and rarely examine attitudes between countries or regions. In order to investigate attitudes from a macro perspective, this study used a systematic literature review method to synthesize findings on attitudes toward EMI in East Asia and the Gulf. The review was guided by the following research questions: (1) What are the attitudes toward EMI in countries in the Gulf and East Asia? and (2) What are the similarities/differences between countries and what factors can be attributed to these? Attitude scores were calculated for twenty studies from ten countries, and the studies were coded by common themes affecting EMI attitudes. Results show that factors affecting attitudes include language and content issues, choice of medium of instruction, instructor quality, motivation to learn English, and deficit views of the L1. As a result of the findings, it is suggested that governments and universities review their EMI policies in order to ensure education quality and maintain the status of local languages.