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Introduction Neurological prognostication after out-of-hospital cardiac arrest (OHCA) remains challenging in the UK, with inequitable access to neuro-physiology, expert neurological assessment and the multi-disciplinary decision making with regards to withdrawal of life-sustaining treatment (WLST) in those with a poor prognosis. Contemporary guidelines recommend delayed, (>72 hours) multimodal neuro-prognostication delivered in the absence of confounders [1]. We describe outcomes, investigation utilisation and decision-making within a structured multidisciplinary team (MDT) neuroprognostication pathway at a tertiary cardiac arrest centre.Methods We conducted an observational cohort study [BCIS OHCA [REC (22/NW/0146)/CAG (22/CAG/0106)] of adult patients admitted to intensive care following OHCA between June 2022 and December 2025. Most patients were of shockable arrest rhythm due our pre-hospital rhythm-based triage system. Patients remaining unconscious following a sedation hold at ≥72 hours post-arrest were managed within a formal MDT neuroprognostication pathway. Data was extracted from electronic health records. Collected variables included arrest characteristics, MIRACLE-2 score [2], neuro-prognostication investigations (CT, MRI, EEG, SSEP, Neuron-Specific Enolase (NSE)), MDT outcomes, WLST timing, survival, and neurological outcome using the Cerebral Performance Category (CPC) [3]. Favourable neurological outcome was defined as CPC 1–2.Results A total of 310 patients were admitted to ICU following OHCA (mean age 63.8±13.7 years; 82.3% male). Overall ICU survival was 58.7% (n=182). Among survivors, 86.8% achieved favourable neurological outcome (CPC 1–2). WLST accounted for 23.2% (n=72) of deaths, while 18.1% (n=56) died from cardiorespiratory deterioration. Patients undergoing WLST had higher baseline neurological risk (median MIRACLE-2 score 5.0, IQR 4.0–6.0). Multimodal neuro-prognostication was widely utilised in WLST patients: CT brain imaging in 100%, EEG in 90.3%, SSEP in 88.9%, NSE in 91.7%, and MRI in 27.8%. Overall, 95.8% received ≥2 prognostic modalities. Median time to WLST was 5 days (IQR 4–8).Conclusion Within a tertiary cardiac arrest centre, a structured MDT neuroprognostication pathway was associated with high ICU survival and predominantly favourable neurological outcomes among survivors. Importantly, WLST decisions were typically made around day 5 post-arrest (median 5 days, IQR 4–8), supporting decisions followed delayed, guideline-concordant, multimodal assessment rather than early baseline risk stratification alone. These findings demonstrate the feasibility of routine MDT-led neuroprognostication in practice and provide contemporary benchmark data for UK post-cardiac arrest care.