Electrochemiluminescence (ECL) is a chemiluminescence phenomenon triggered by electrochemical reactions and is widely used for (bio)chemical analyses and electrochemical bioimaging. Compared to fluorescence sensing, ECL sensing reduces background noise by eliminating autofluorescence associated with excitation light. In addition, compared with conventional electrochemical imaging with scanning electrochemical microscopes, ECL imaging is faster as it requires no scanning. Furthermore, unlike electrode arrays, ECL devices can function without complex wiring, simplifying their construction. These characteristics render ECL sensing a useful analytical tool. Recently, ECL sensing has been widely used for in vitro cell analysis due to high demand for biochips in regenerative medicine, drug screening, and microphysiological systems. This review focuses on recent advancements in ECL-based cell analysis with applications for the detection of H2O2, respiration activity, cell adhesion, lipid membranes, and bipolar electrochemistry-based devices.